Weigang Yan

Anatomic features involved in technical complexity of partial nephrectomy.

Nephrometry score systems, including RENAL nephrometry, preoperative aspects and dimensions used for an anatomical classification system, C-index, diameter-axial-polar nephrometry, contact surface area score, calculating resected and ischemized volume, renal tumor invasion index, surgical approach renal ranking score, zonal NePhRO score, and renal pelvic score, have been reviewed. Moreover, salient anatomic features like the perinephric fat and vascular variants also have been discussed. We then extract 7 anatomic characteristics, namely tumor size, spatial location, adjacency, exophytic/endophytic extension, vascular variants, pelvic anatomy, and perinephric fat as important features for partial nephrectomy. For novice surgeons, comprehensive and adequate anatomic consideration may help them in their early clinical practice.

The diagnosis and surgical management of juxtaglomerular cell tumor of the kidney

Juxtaglomerular cell tumor (JCT) of the kidney is a rare benign renal neoplasm. Four cases of JCT of the kidney have been diagnosed and treated surgically in our hospital from January 2005 to August 2008. The clinical features, laboratory examination, imaging examination, pathological results and electron microscopy examination were analyzed, and a review of the literature was summarized. Three patients underwent open partial nephrectomy, and one patient underwent laparoscopic partial nephrectomy. Pathological examination confirmed the final diagnosis of JCT of the kidney. The blood pressure, potassium, renin and aldosterone remained within the normal range after surgery. JCT of the kidney should be kept in mind because they represent a surgically curable cause of secondary hypertension. Nephron-sparing surgery is recommended.

Retroperitoneal Laparoscopic Management of Paraganglioma: A Single Institute Experience.

Objectives To explore the feasibility and safety of retroperitoneal laparoscopic resection of paraganglioma (RLPG) in a large study population. Methods In a six-year period, 49 patients with primary retroperitoneal paragangliomas (PG) underwent retroperitoneal laparoscopic surgery in a single center. Medical records were reviewed, and collected the following data, which were clinical characteristics, perioperative data (operative time, estimated blood loss, intraoperative hemodynamic changes, intraoperative and postoperative complications, and open conversions), and follow-up data (recurrence or distant metastases). Results All PGs were removed with negative tumor margin confirmed by postoperative histopathology. The operative time of RLPG was 101.59±31.12 minutes, and the estimated blood loss was 169.78±176.70ml. Intraoperative hypertensive and hypotensive episodes occurred in 25 cases and 27 cases, respectively. Two open conversions occurred. Two intraoperative complications occurred but were successfully managed endoscopically. Postoperative complications were minor and unremarkable. No local recurrence or distant metastasis were observed during the follow-up period. Conclusions Our experience indicates the feasibility and safety of resection of PGs in a relatively large study population.

Experience of Retroperitoneal Laparoscopic Treatment on Pheochromocytoma

OBJECTIVES To evaluate the safety and efficacy of retroperitoneal laparoscopic resection for pheochromocytoma. METHODS The clinical data of 131 cases of pheochromocytoma were analyzed retrospectively. There were 69 males and 62 females with an age range of 8 to 77 years, including 120 cases of adrenal pheochromocytoma and 11 extraadrenal pheochromocytomas. Retroperitoneal laparoscopic resection was performed in all cases. We divided our practical experience into three stages: (1) the tentative and exploratory stage, (2) the accumulative stage, and (3) the mature stage. RESULTS During the tentative and exploratory stage, 10 patients underwent retroperitoneal laparoscopic surgery. The mean diameter of the tumor was 4.2 cm. The mean operation time was 105 minutes, and the median volume of blood loss during surgery was 450 mL. During the accumulative stage, the mean tumor diameter of the 72 cases was 5.6 cm. The mean operation time was 85 minutes and median volume of blood loss was 140 mL. During the mature stage, the mean tumor diameter of the 49 cases (including 11 extra-adrenal pheochromocytoma patients) was 6.7 cm. The mean operation time was 75 minutes and median volume of blood loss was 70 mL. Follow-ups ranging from 1 to 70 months were conducted, with three cases recurring. There were no cases of distant metastases or death. CONCLUSIONS Retroperitoneal laparoscopic surgery for pheochromocytoma is feasible and safe. This procedure will be increasingly performed as medical personnel continue to develop their skills and accumulate experience.

Comparison of retroperitoneoscopic versus transperitoneoscopic resection of retroperitoneal paraganglioma: a control study of 74 cases at a single institution.

AbstractWe aimed to compare the safety and patient outcomes of retroperitoneal paraganglioma (PG) following the retroperitoneoscopic and transperitoneoscopic approaches based on large samples.Seventy-four patients with retroperitoneal PG undergoing laparoscopic resection from June 2004 to September 2013 were retrospectively included. The patients were divided into the retroperitoneal (n = 40) and transperitoneal (n = 34) groups. Demographic and perioperative data, including the operation time, estimated blood loss, incidence of intraoperative hypertension, bowel recovery day, postoperative hospital stay, and systemic inflammatory response syndrome (SIRS) were recorded.The retroperitoneal group showed a shorter operation time and earlier postoperative exsufflation time compared with the transperitoneal group (84 ± 28.5 minutes vs 115 ± 35.7 minutes and 1.7 ± 0.6 vs 2.3 ± 0.7 day, respectively; both P < 0.001). No significant differences in the baseline data were observed between 2 groups. All patients, except for 1 case of open conversion, underwent laparoscopic surgery. There were no patient deaths. Data analysis demonstrated no significant difference in the surgical blood loss, incidence of surgical blood pressure elevation, postoperative hospital stay, or incidence of SIRS between 2 groups.The operation time for the retroperitoneoscopic resection of retroperitoneal PG is shorter, and gastrointestinal functions improve more quickly compared to the transperitoneoscopic approach. This study may provide a valuable source of clinical information for clinicians in related fields.

Comparison of lesions detected and undetected by template‐guided transperineal saturation prostate biopsy

To compare the characteristics of lesions detected or undetected by template‐guided transperineal saturation prostate biopsy and to evaluate the potential impact of undetected lesions.

Transperineal template-guided prostate biopsy: 10 years of experience

To assess the efficacy and safety of transperineal template‐guided prostate biopsy.

Laparoscopic Nephron Sparing Surgery Assisted with Laparoscopic Ultrasonography on Centrally Located Renal Tumor - Single Center Experience

Objective: To investigate the clinical value of laparoscopic nephron sparing surgery (LNSS) assisted with laparoscopic ultrasonography (LUS) on centrally located renal tumors. Materials and Methods: Clinical data of 19 patients who underwent LNSS on centrally located renal tumors assisted with LUS were retrospectively analyzed. LUS was used to confirm the location, size, blood supply, and boundary of renal tumors, and to confirm that the tumor was removed completely with negative margin. Results: The 19 centrally located renal tumors were deep in renal parenchyma without obvious convex. Eleven cases were in the middle of the kidney, 3 cases were in the upper pole, and 5 cases were in the inferior pole. The tumor size was in the range 1.0-3.9 cm, with an average of 2.46 cm. The pathological results were 13 cases of renal clear cell carcinoma, 1 case of reninoma, 1 case of renal cyst, and 3 cases of angioleiomyolipoma. The surgical margins were negative in all 19 cases. Conclusions: LUS has a high clinical value in LNNS on centrally located renal tumors and it helps to determine the location of centrally located tumors and guarantee negative margins.

Surgical Management and Clinical Prognosis of Adrenocortical Carcinoma

Objective: To study the relationship between surgical management and prognosis of adrenocortical carcinoma (ACC) in order to guide the surgical management of ACC. Methods: Clinical data of 45 cases of ACC treated in our hospital were retrospectively analyzed. The 45 cases included 3 cases in stage I, 12 cases in stage II, 7 cases in stage III, and 23 cases in stage IV. 17 cases underwent complete excision, 14 cases underwent palliative excision, 8 cases had non-operative treatment and 6 cases gave up treatment. All patients were followed up from 2 to 141 months. Results: The average survival time of 31 patients with surgery was 32.46 months, and the average survival time of 14 patients without surgery was 4.75 months. There were statistically significant differences between the two groups (p < 0.01). There were no statistically significant differences between the two groups in survival time in stage III and stage IV (p > 0.05). Conclusions: Surgery is considered to be the only method to cure ACC. For ACC in stage I and II, tumor resection is the most effective treatment, and second surgical operation is recommended for local recurrence. For ACC in stage III, extensive surgical operation is recommended, and for ACC in stage IV, surgical operation has no effect on the prognosis.

The biological functions and mechanism of miR‑212 in prostate cancer proliferation, migration and invasion via targeting Engrailed-2

Accumulating evidence indicates that Engrailed-2 (EN-2), which is a homeobox-containing transcription factor, act as a candidate oncogene in prostate cancer (PCa). Even though there are some treatments targeting EN-2, however, it is limited because the mechanism of EN-2 upregulation in PCa cells is still unknown. In this study, we investigate the role of miR-212 on EN-2 expression and explored the mechanism of prostate cancer survival and metastasis. The relative expression levels of miR-212 and EN-2 in PCa samples and adjacent normal tissues as well as in PCa cell lines were detected by using quantitative real-time PCR. CCK-8, TUNEL and Transwell assays were used to analyze cell proliferation, apoptosis and invasion, respectively. EN-2 was identified as a direct target of miR-212 via luciferase reporter and western blot assays. Results showed that the expression level of miR-212 was downregulated in both PCa samples and PCa cell lines when compared with prostate epithelial cells and the adjacent no tumor tissues. Moreover, we found that overexpression of miR-212 suppressed PCa cell proliferation and invasion, promoted PCa cell apoptosis. EN-2 was identified as a direct target gene of miR-212 by using luciferase reporter and western blot assays. Also, the expression of EN-2 and miR-212 in the PCa cells had an opposite correlation. The critical role of miR-212 in inhibiting prostate tumor growth was verified in xenograft models of prostate cancer. These findings highlighted the role of miR-212 in PCa progression. More importantly, we speculate that EN-2 is a direct target gene of miR-212.