Robot-assisted Radical Cystectomy with Intracorporeal Urinary Diversion following Neoadjuvant Chemotherapy for Muscle-invasive Bladder Cancer: An Initial Experience

Objective: To investigate the outcomes of robot-assisted radical cystectomy, intracorporeal urinary diversion, and extended lymph node dissection in patients with muscle-invasive bladder cancer who underwent neoadjuvant chemotherapy. Materials and Methods: A total of 14 patients underwent neoadjuvant chemotherapy for invasive bladder tumors, followed by robot-assisted radical cystectomy, extended lymph node dissection, and intracorporeal urinary diversion. Demographic, operative, and postoperative information of the patients was retrospectively evaluated. Gemcitabine plus cisplatin and cisplatin plus etoposide regimens were used as neoadjuvant treatments. Early and late-term complications were recorded. Results: In the early postoperative period (0-30 days), Clavien-Dindo grade 2 complications occurred in 6 patients and grade 3 complications in 2 patients. In the late postoperative period (31-90 days), Clavien-Dindo grade 2 complications occurred in 1 patient and grade 3 complications in 1 patient. The mean follow-up period was 15.5±5.7 months. Conclusion: Although the intracorporeal technique is more demanding in terms of learning and use, preoperative chemotherapy application should not be seen as a limitation in the application of this technique

Clinical aspects of renal cell carcinoma

Renal cell carcinoma (RCC) represents a heterogeneous group of tumors, the most common of which is clear cell adenocarcinoma. RCC accounts for 3% of adult tumors. The incidence has increased more than 30% over the past two decades. It is generally postulated that the increased incidence rates reflect earlier diagnosis at an earlier stage, largely due to more liberal use of radiological imaging techniques. However, advanced disease has also been diagnosed more frequently and the mortality rate has increased as well. Prevention of RCC should focus on smoking cessation and maintaining ideal body mass index. Familial forms of kidney cancer have been described on four distinct histological patterns: clear cell, papillary, chromophobe, and oncocytoma. Genetic forms afflict individuals at an earlier age with a multifocal and recurrent pattern; therefore, nephron-sparing procedures should be the treatment of choice for these patients. The yield of screening the general population for RCC is still relatively low and hence not cost-effective. Screening should be reserved for individuals who carry high risk for RCC. The classic triad of flank pain, macroscopic hematuria, and palpable abdominal mass is now detected in fewer than 10% of patients, and is a late sign. Today, most tumors are diagnosed incidentally. Paraneoplastic syndromes have been reported in 10-40% of patients and can be seen at any stage of disease. The indications and application of percutaneous biopsy for renal masses are limited and mainly used to make differential diagnosis with an infectious process, lymphoma and metastases to the kidney. © 2003 Elsevier B.V. All rights reserved

Age as a prognostic factor for disease recurrence after radical prostatectomy

Objectives. To assess whether age has an impact on biochemical recurrence after radical prostatectomy for localized adenocarcinoma of the prostate. Methods. Four hundred eighty-nine consecutive patients who underwent radical retropubic prostatectomy and did not have metastases to the lymph nodes were retrospectively analyzed. Disease recurrence was defined as a serum prostate-specific antigen greater than 0.2 ng/mL and rising on at least two postoperative measurements. Biochemical progression was compared in patients 70 years old or younger and older than age 70. The Kaplan-Meier estimator and Cox’s proportional hazards model were employed to investigate the impact of age on time to recurrence. Neoadjuvant androgen deprivation was treated as a stratification variable in the Cox models. Results. The mean follow-up was 25.4 ± 20.8 months. The Gleason score and extent of cancer in the pathologic analyses of the prostatectomy specimen was not significantly different between the two groups. Biochemical recurrence was detected in 12% of patients 70 years old or younger and in 25% of those older than 70 ( P = 0.01). In multivariate analyses, after adjusting for all prognostic factors, younger age (70 years or younger) was independently associated with a longer time to recurrence ( P <0.02). Conclusions. Our results suggest that age per se may be an independent prognostic factor for disease recurrence after radical prostatectomy. This implies that patients 70 years old or younger are more likely to benefit from surgery. This information may be useful when counseling patients with clinically localized carcinoma of the prostate

Positive surgical margins with radical retropubic prostatectomy: anatomic site-specific pathologic analysis and impact on prognosis

Objectives. To correlate the extent and location of positive surgical margins after radical prostatectomy with disease progression. Methods. Data on 495 patients who underwent radical prostatectomy by one surgeon were analyzed. All radical prostatectomy specimens were sectioned entirely using 2 to 3-mm step sections by one pathologist. One hundred fifty-one patients (30.5%) had one or more positive surgical margins and were subjected to further detailed analysis. Recurrence was defined as a serum prostate-specific antigen (PSA) level of 0.2 ng/mL and rising on at least two postoperative measurements. Results. The mean follow-up was 25.3 months (range 3 to 73). The overall recurrence rate was 13.3%. Neoadjuvant hormonal treatment was given to 37 (25%) of those with a positive margin. Patients with positive surgical margins had a significantly higher incidence of recurrence compared with those with negative margins (27.8% versus 6.9%, P = 0.001). The recurrence rate for various locations was 29% apex/urethra, 30% posterior, 33% anterior, 36% lateral, 48% posterolateral, and 57% bladder neck. Time to recurrence was shorter in patients older than 70 years ( P <0.055); with a preoperative PSA greater than 10 ng/mL ( P <0.0001); with a biopsy Gleason score greater than 7 ( P = 0.02); with a prostatectomy Gleason score greater than 7 ( P <0.001); with seminal vesicle invasion ( P = 0.0001); having more than 1 location of a positive margin ( P = 0.002); or having a positive margin at the bladder neck ( P = 0.0003) or the posterolateral surface of the prostate ( P = 0.02) compared with other locations. Multivariate proportional hazards analyses indicated that age older than 70 ( P = 0.005), a prostatectomy Gleason score of 7 ( P = 0.015) or 8 to 10 ( P = 0.003), and positive margin(s) at the bladder neck ( P = 0.003) were independently associated with a shorter time to recurrence among patients with a positive margin. Conclusions. In our study, among patients with positive surgical margins, those with multiple positive margins, or a margin involving the bladder neck or the posterolateral surface of the specimen carried a higher risk of progression. A positive margin at the bladder neck appears to be the most significant adverse prognostic indicator. This information may help in decisions regarding additional therapy

Radical retropubic prostatectomy as a solo therapy for treatment of adult rhabdomyosarcoma.

İstanbul Bilim Üniversitesi, Tıp Fakültesi.INTRODUCTION Incidence of prostate rhabdomyosarcoma in adults is not yet known. Together with other sarcoma subtypes they cover less than 0.1% of the primary prostate malignancies.(1) We report an adult patient diagnosed with localized rhabdomyosarcoma treated with radical prostatectomy alone