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178 Abstracts

  • Introduction & Objectives

    In recent years, nephron-sparing surgery has replaced radical nephrectomy as the treatment of choice for patients with localized renal cell carcinoma (RCC). Oncological outcomes appear to be similar, with less reduction in renal function. Although initially reserved for T1a tumours and imperative indications, partial nephrectomy is now being performed in patients with larger renal masses, when feasible. The aim of this work is to compare laparoscopic versus open partial nephrectomy for the treatment of >4cm RCC.

    Material & Methods

    The authors retrospectively evaluated a group of 81 patients who underwent open or laparoscopic partial nephrectomy for >4cm RCC between January 2005 and June 2015 in a single department. Patient demographics, clinical symptoms, histopathologic factors, intraoperative and postoperative data were compared between the 2 groups. Statistical analysis was performed using SPSS V20.0.

    Results

    A total of 38 (46.9%) laparoscopic and 43 (53.1%) open partial nephrectomies were performed for tumours > 4cm, during the aforementioned period. 62 (76.5%) patients were males and 19 (23.5%) females, with a mean age of 61±1 years, ranging between 26 and 88 years. Most of them were asymptomatic (76.5%) and the most prevalent symptom was flank pain (8.6%). The mean tumour size was 5.48±0.19cm (4.1-16 cm). Pathological stage T1b, T2a, T3a and T3b was found in 66 (81.5%), 6 (7.4%), 8 (9.9%) and 1 (1.2%) of cases, respectively. The majority of tumours were of clear cell histology (49.4%) and Furhman grade 2 (49.4%). There were no statistically significant differences in demographics, presenting symptoms and histopathological factors between the 2 groups. Laparoscopic approach was more often performed in the five latest years (p=0.034). Tumour size was comparable in both open and laparoscopic surgeries (p=0.337), but there were significantly more endophytic tumors in the open surgery group (p=0.05). The mean operative time was 132±6.9min for open surgery and 151±7.2min for the laparoscopic group (p=0.05). Blood loss and warm ischemia time in open surgery (334±62.0mL and 16.6±1.4min) did not differ significantly from laparoscopic approach (307±44.9mL and 19.7±1.0min; p=0.727 and p=0.099, respectively). In the postoperative period, the overall complication rate was 25.9%. Urinary fistula was the most common complication (14.8%), and was not significantly different in both types of surgery (p=0.307). According to the Clavien-Dindo classification, the number of patients with grade 3, 4 and 5 was 13 (16.1%), 1 (1.2%) and 1 (1.2%), respectively. Nephrectomy due to persistent urinary fistula was performed in 1 (1.23%) following laparoscopic and in 6 (7.4%) following open surgery (p=0.761). The length of hospital stay was 7.4±1.3 days and 5.3±0.4 days following open and laparoscopic partial nephrectomy (p=0.137), respectively.

    Conclusions

    For renal tumours larger than 4cm, partial nephrectomy can be performed whenever technically possible with good results and acceptable complication rates. Our data suggest that laparoscopic technique is an effective, minimally invasive therapeutic approach, with no significant increase in warm ischemia time, intraoperative or postoperative surgical complications compared with open surgery. It also has the advantage of an earlier hospital discharge (although not statistically significant in our series).

  • Introduction & Objectives

    Decrease in the peripheral blood leukocyte count is a well-known side effect of radiation therapy for prostate cancer and it is considered a negative prognostic factor. Beside the direct toxicity to the bone marrow, a redistribution of circulating leukocytes after pelvic irradiation is also a relevant factor, which is still poorly investigated.

    Material & Methods

    We have set up an animal model to allow tracking of peripheral leukocyte relocation after radiation treatment focused to the urinary bladder. This method will serve to investigate a possible selective accumulation of circulating leucocytes to specific anatomical districts affected by the radiations. Fisher female rats (n=6) were adoptively transferred IV with 4x107 VivoTag-750-labelled syngeneic primary splenocytes, two hours before bladder irradiation. Animals were transurethrally catheterized to allow contrast agent instillation and undergone to a kV cone beam computed tomography (CBCT) imaging to precisely deliver monofraction radiation treatment (15-25 Gy range). Bladder tissue reaction to the radiation was followed over time by ultrasonography, while possible accumulation sites of labelled leukocytes were evaluated by in vivo fluorescent imaging.

    Results

    Preliminary results show that a significant increase in the bladder wall thickness peaked 4 days after radiotreatment in animals treated at a dose of 25 Gy. A fluorescent signal, secondary to labelled splenocytes accumulation, was detectable in the liver and lymph nodes of all adoptively transferred rats, 2 and 6 days after transfer, as expected. A modest specific signal (30% increase) at the bladder level was detected only in animals (n=2) subjected to 25 Gy irradiation (figure 1.a), when compared to the non-irradiated controls (n=3) (figure 1.b). No specific fluorescent signal was detected at the bladder levels in animals treated with 20 and 15 Gy (n=2/group).

    Conclusions

    These data suggest that relocalization to the damaged tissue of peripheral leukocytes can be followed in a non-invasive way and may occur dependently on the radiation dosage. Further analyses are currently ongoing.

  • Introduction & Objectives

    In recent decades, partial nephrectomy has replaced radical nephrectomy as the treatment of choice for patients with localized renal cell carcinoma (RCC), mostly for T1a tumours. However, partial nephrectomy is being increasingly performed in the setting of stage ≥T1b RCC, with good oncological outcomes. The aim of this work was to investigate the prognostic significance of positive surgical margins after partial nephrectomy in pathologic stages T1b to T3b in terms of recurrence rate and recurrence-free survival.

    Material & Methods

    The authors retrospectively evaluated a group of 85 patients who underwent partial nephrectomy (open or laparoscopic) for T1b-T3b RCC between January 2005 and June 2015 in a single Department. Characteristics evaluated included patient demographics, type of surgical approach, intraoperative data, tumour size, histological factors including surgical margins, recurrence rate and recurrence-free survival.
    Statistical analysis was performed using SPSS V22.0.

    Results

    A total of 85 patients were submitted to partial nephrectomy for T1b-T3b RCC during the aforementioned period. 65 (76.5%) patients were males and 20 (23.5%) females, with a mean age of 61±1 years, ranging between 26 and 88 years. 41 (48.2%) patients underwent laparoscopic and 44 (51.8%) open partial nephrectomy. During surgery, the mean blood loss was 321±37.0mL (20-1300mL) and the mean warm ischemia time 18±1.0min (0-45min). The mean tumour size was 5.36±0.2cm (2.2-16cm) and pathological stages T1b, T2a, T3a and T3b were found in 66 (77.6%), 6 (7.1%), 12 (14.1%) and 1 (1.2%) of cases, respectively. The majority of tumours were of clear cell histology (49.4%), 24 (28.2%) were chromophobic and 19 (22.4%) papillary. Furhman grade 1, 2, 3 and 4 was found in 12 (15.2%), 41 (51.9%), 24 (30.4%) and 2 (2.5%) of cases, respectively.
    Positive surgical margins were found in 5 (5.9%) patients, 1 after laparoscopic approach and 4 after open surgery (p=0.193). Comparing patients with positive surgical margins and the ones with negative surgical margins, there were no significant differences in intraoperative blood loss (p=0.876), warm ischemia time (p=0.630), tumour size (p=0.837) or Furhman grade (p=0.925).
    After a mean time of follow-up of 33 months, there were 2 confirmed recurrences. The overall recurrence-free survival rate was 97.2%. There was no statistical significant difference in survival when comparing patients with positive or negative surgical margins (p=0.798) operated by open or laparoscopic approaches (p=0.253), Furhman grade (p=0.714), histological subtypes (p=0.334) and endophytic or exophytic tumours (p=0.502). When comparing tumours larger and smaller than 6cm, there was a significant lower recurrence-free survival in the first group (p=0.001).

    Conclusions

    Partial nephrectomy is a safe procedure in pathologic stages T1b to T3b with low rates of positive surgical margins. Patients with positive surgical margins had no decrease in recurrence-free survival. We found a significant lower recurrence-free survival only in patients with tumours larger than 6cm, unrelated with margin status.

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