F.A. Mistretta

Outcomes of robot-assisted simple enucleation of renal masses: A single European center experience

Abstract The aim of this study was to assess the ability of pre-and intraoperative parameters, to predict the risk of perioperative complications after robot-assisted laparoscopic simple enucleation (RASE) of renal masses, and to evaluate the rate of trifecta achievement of this approach stratifying the cohort according to the use of ischemia during the enucleation. From April 2009 to June 2016, 129 patients underwent RASE at our Institution. We stratified the procedures in 2 groups: clamping and clamp-less RASE. After RASE, all specimens were retrospectively reviewed to assess the surface–intermediate–base (SIB) scoring system. Patients were followed-up according to the European Association of Urology guidelines recommendations. All pre-, intra-, and postoperative outcomes were prospectively collected in a customized database and retrospectively analyzed. A total of 112 (86.8%) patients underwent a pure RASE and 17 (13.2%) had a hybrid according to SIB classification system. The mean age was 61.17 years. In 21 patients (16.3%), complications occurred, 13 (61.9%) were Clavien 1 and 2, while 8 were Clavien 3a and b complications. Statistical significant association with complications was found in patients with American Society of Anestesiology (ASA) score 3 (44.5%, Pu200a=u200a.04), longer mean operative time (OT) 195 versus 161.36u200aminutes (Pu200a=.03), mean postoperative hemoglobin (Hb) 10.1 versus 11.8 (Pu200a<.001), and mean &Dgr;Hb 3.59 versus 2.18 (Pu200a<.001). In multivariate logistic regression, only longer OT and &Dgr;Hb were statistical significant predictive factors for complications. In sub-group analysis, clamp-less RASE was safe in terms of complications (14.1%), positive surgical margins (1.3%), and mid-term local recurrence (1.3%). Although in this approach there is higher EBL (Pu200a=u200a.01), this had no impact on &Dgr;Hb (Pu200a=u200a.28). A clamp-less approach was associated with a higher rate of SIB 0 (71.8% vs 51%, Pu200a=u200a.02), higher trifecta achievement (84.6% vs 62.7%, Pu200a=u200a.004), and better impact on serum creatinine (mean 0.83 vs 0.91, Pu200a=u200a.01). RASE of renal tumors is a safe technique with very good postoperative outcomes. Complication rate is low and associated with ASA score >3, longer OT, and &Dgr;Hb. RASE is suitable for the clamp-less approach, which allows to perform easier the pure enucleation (SIB 0) and to obtain higher rates of trifecta outcomes.

Robot-assisted Partial Nephrectomy: 5-yr Oncological Outcomes at a Single European Tertiary Cancer Center

BACKGROUNDnNowadays, there is a debate about which surgical treatment should be best for clinical T1 renal tumors. If the oncological outcomes are considered, there are many open and laparoscopic series published. As far as robotic series are concerned, only a few of them report 5-yr oncological outcomes.nnnOBJECTIVEnThe aim of this study was to analyze robot-assisted partial nephrectomy (RAPN) midterm oncological outcomes achieved in a tertiary robotic reference center.nnnDESIGN, SETTING, AND PARTICIPANTSnBetween April 2009 and September 2013, 123 consecutive patients with clinical T1-stage renal masses underwent RAPN in our tertiary cancer center. Inclusion criteria were as follows: pathologically confirmed renal cell carcinomas (RCCs) and follow-up for >12 mo. Eighteen patients were excluded due to follow-up of <12 mo and 15 due to benign final pathology. Median follow-up was 59 mo (interquartile range 44-73 mo). Patients were followed according to guideline recommendations and institutional protocol.nnnOUTCOME MEASUREMENTS AND STATISTICAL ANALYSISnOutcomes were measured by time to disease progression, overall survival, or time to cancer-specific death. Kaplan-Meier method was used to estimate survival; log-rank tests were applied for pair-wise comparison of survival.nnnRESULTS AND LIMITATIONSnFrom the 90 patients included, 66 (73.3%) had T1a, 12 (13.3%) T1b, three (3.3%) T2a, and nine (10%) T3a tumors. Predominant histological type was clear cell carcinoma: 67 (74.5%). Fuhrmann grade 1 and 2 was found in 73.3% of all malignant tumors. Two patients (2.2%) had positive surgical margins, and complication rate was 17.8%. Relapse rate was 7.7%, including two cases (2.2%) of local recurrences and five (5.5%) distant metastasis. Five-year disease-free survival was 90.9%, 5-yr cancer-specific survival was 97.5%, and 5-yr overall survival was 95.1%.nnnCONCLUSIONSnMidterm oncological outcomes after RAPN for localized RCCs (predominantly T1a tumors of low anatomic complexity) were shown to be good, adding significant evidence to support the oncological efficacy and safety of RAPN for the treatment of this type of tumors.nnnPATIENT SUMMARYnRobot-assisted partial nephrectomy seems to be the most promising minimally invasive approach in the treatment of renal masses suitable for organ-sparing surgery as midterm (5 yr) oncological outcomes are excellent.

Meta-analysis of studies comparing oncologic outcomes of radical prostatectomy and brachytherapy for localized prostate cancer

Background: The aim of this study was to compare oncologic outcomes of radical prostatectomy (RP) with brachytherapy (BT). Methods: A literature review was conducted according to the ‘Preferred reporting items for systematic reviews and meta-analyses’ (PRISMA) statement. We included studies reporting comparative oncologic outcomes of RP versus BT for localized prostate cancer (PCa). From each comparative study, we extracted the study design, the number and features of the included patients, and the oncologic outcomes expressed as all-cause mortality (ACM), PCa-specific mortality (PCSM) or, when the former were unavailable, as biochemical recurrence (BCR). All of the data retrieved from the selected studies were recorded in an electronic database. Cumulative analysis was conducted using the Review Manager version 5.3 software, designed for composing Cochrane Reviews (Cochrane Collaboration, Oxford, UK). Statistical heterogeneity was tested using the Chi-square test. Results: Our cumulative analysis did not show any significant difference in terms of BCR, ACM or PCSM rates between the RP and BT cohorts. Only three studies reported risk-stratified outcomes of intermediate- and high-risk patients, which are the most prone to treatment failure. Conclusions: our analysis suggested that RP and BT may have similar oncologic outcomes. However, the analysis included a limited number of studies, and most of them were retrospective, making it impossible to derive any definitive conclusion, especially for intermediate- and high-risk patients. In this scenario, appropriate urologic counseling remains of utmost importance.

Thulium laser treatment of early stage penile cancer: Initial results and functional outcomes

Introduction and Objectives Traditional surgical treatment of penile carcinoma was amputation of the glans, resulting in organ dysfunction and disfigurement, with a strong impact on patient’s quality of life. Several conservative treatment modalities have been introduced with the goal of achieving conservative treatment. We present the initial experience with thulium laser excision of early stage penile lesions.

Safety of testicular prosthesis insertion at the time of radical orchiectomy for testis cancer in patients undergoing adjuvant therapies

Introduction Since the introduction of platinum-based chemotherapy (ChT), long-term survival following testicular cancer (TC) is now the norm; thus, quality of life after radical orchiectomy became of paramount importance. Testicular prostheses have been used since 1941. The first model was composed of vitallium. Nowadays, silicon-gel filled, saline-filled and elastomer prostheses are available. The safety of the concurrent insertion of a prosthesis in course of radical orchiectomy in terms peri-operative complications has already been assessed. Aim of this study was to assess if the insertion of a testicular prosthesis at the time of radical orchiectomy was related to a higher incidence of complications in patients undergoing adjuvant treatments.