Letter to the editor on "Stents and surgical interventions in the palliation of gastric outlet obstruction. A systematic review"

We read with interest the paper, “Stents and surgical interventions in the palliation of gastric outlet obstruction: a systematic review” by Minata MK et al, which appeared in Endoscopy International Open (2016; 4: E1158 – 1170) [1]. The Authors should be congratulated for an extensive and careful review. In recent studies, we prospectively analyzed the clinical outcomes of 72 patients [2, 3] and we came to similar conclusions. We have abandoned the use of covered stents. Distal migration of a covered stent can lead to serious consequences and a stent rarely can be retrieved endoscopically [4]. Endoscopic stenting offers many advantages in comparison to surgery: shorter hospital stay, faster return to oral intake, a less invasive procedure. However, life expectance may be longer than 1 year in some patients with malignant gastric outlet obstruction, particularly those with distal gastric cancer or gastric obstruction from metastatic disease. In this selected group of patients, food obstruction is common. The reason for it in rare cases derives from tumor ingrowth within the stent; in the majority of patients, food obstruction is secondary to dismotility of the pyloric region. The dismotility depends on many factors, including nerve infiltration by the tumor. Food obstruction is not easily diagnosed. The stomach can enlarge significantly before vomiting occurs. Stomach dilation can lead to nausea, discomfort, and dyspnea, symptoms that easily can be attributed to the cancer itself. For all these reasons, patients who have endoscopic stenting in this clinical setting should have a very careful follow-up with repeated endoscopies and computed tomography scan. This careful follow-up may not be well tolerated by a patient whose general condition is slowly deteriorating or for his or her family. Laparoscopic surgery can be performed with minimal discomfort for patients and it should be seriously considered in patients whose conditions are generally acceptable. Before such a procedure, the patient and family should be consulted and all positive and negative aspects of the surgery should be thoroughly explained, leaving them to choose the preferred treatment

Machine Learning Techniques in Prostate Cancer Diagnosis According to Prostate-Specific Antigen Levels and Prostate Cancer Gene 3 Score

Purpose: To explore the role of artificial intelligence and machine learning (ML) techniques in oncological urology. In recent years, our group investigated the prostate cancer gene 3 (PCA3) score, prostate-specific antigen (PSA), and free-PSA predictive role for prostate cancer (PCa), using the classical binary logistic regression (LR) modeling. In this research, we approached the same clinical problem by several different ML algorithms, to evaluate their performances and feasibility in a real-world evidence PCa detection trial.Materials and Methods: The occurrence of a positive biopsy has been studied in a large cohort of 1,246 Italian men undergoing first or repeat biopsy. Seven supervised ML algorithms were selected to build biomarkers-based predictive models: generalized linear model, gradient boosting machine, eXtreme gradient boosting machine (XGBoost), distributed random forest/ extremely randomized forest, multilayer artificial Deep Neural Network, naïve Bayes classifier, and an automatic ML ensemble function.Results: All the ML models showed better performances in terms of area under curve (AUC) and accuracy, when compared to LR model. Among them, an XGBoost model tuned by the autoML function reached the best metrics (AUC, 0.830), well overtaking LR results (AUC, 0.738). In the variable importance ranking coming from this XGBoost model (accuracy, 0.824), the PCA3 score importance was 3-fold and 4-fold larger, when compared to that of free-PSA and PSA, respectively.Conclusions: The ML approach proved to be feasible and able to achieve good predictive performances with reproducible results: it may thus be recommended, when applied to PCa prediction based on biomarkers fluctuations

Laparoscopic Nephron-Sparing Calycectomy for Treating Fraley's Syndrome

Background/Aims/Objectives: Various nephron-sparing approaches were described as part of surgical management for Fraley's syndrome, a rare anatomic variant of the renal vascular anatomy that compresses the upper pole infundibulum resulting in an upper calyceal obstruction and dilatation, with symptoms of flank pain and hematuria. To date, descriptions of minimally invasive correction techniques are anecdotal. METHODS: A retroperitoneal pure laparoscopic approach using the nephron-sparing technique was chosen in the presented case. RESULTS: In this report, we demonstrated that if laparoscopic calycectomy is performed without clamping of renal branches, parenchymal ischemia can be completely avoided. Additionally, the preservation of renal tissue surrounding the calyx enables the preservation of the intrasinusal segmental arteries flow, thereby avoiding their accidental closure by hemostatic sutures. CONCLUSIONS: In conclusion, Laparoscopic Nephron-Sparing Calycectomy is a safe and effective surgical procedure for the treatment of Fraley's syndrome. Consistent laparoscopic experience is required before embarking on this kind of surgery

Endoscopic stenting for left-sided obstructing colorectal cancer

Si sottolinea l'importanza dello stenting endoscopico in pazienti con occlusione da tumore del colon rett

Positive aspects of self-expandable metallic stent endoscopic placement for malignant colorectal obstruction during the COVID-19 pandemic

Lo studio sottolinea l'importanza e l'utilità di stents posizionati per via endoscopica in caso di occlusione acuta-subacuta per tumore del colon retto, nel periodo della pandemia da COVID 1

Erratum to: Single‐Photon‐Emission Computed Tomography (SPECT) with Technetium‐99m Sestamibi in the Diagnosis of Small Breast Cancer and Axillary Lymph Node Involvement

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Total Anatomical Reconstruction during Robot-assisted Radical Prostatectomy: Implications on Early Recovery of Urinary Continence

Background: The introduction of robotics revolutionized prostate cancer surgery because the magnified three-dimensional vision system and wristed instruments allow microsurgery to be performed. The advantages of robotic surgery could lead to improved continence outcomes in terms of early recovery compared with the traditional surgical methods. Objective: To describe the total anatomical reconstruction (TAR) technique during robot-assisted radical prostatectomy (RARP). Primary endpoint: evaluation of the continence rate at different time points. Secondary endpoint: evaluation of urine leakage and anastomosis stenosis rates related to the technique. Design, setting, and participants: June, 2013 to November, 2014; prospective consecutive series of patients with localized prostate cancer (cT1-3, cN0, cM0). Surgical procedure: RARP with TAR was performed in all cases. Lymph node dissection was performed if the risk of lymph nodal metastasis was over 5%, according to the Briganti updated nomogram. Measurements: Preoperative, intraoperative, postoperative, and pathological variables were analyzed. Enrolled patients were arbitrarily divided into three groups according to a time criterion. The relationships between the learning curve and the trend of the above-mentioned variables were analyzed using LOESS analysis. Continence was rigorously analyzed preoperatively and at 24h, 1 wk, 4 wk, 12 wk, and 24 wk after catheter removal. Results and limitations: In total, 252 patients were analyzed. The continence rates immediately after catheter removal and at 1 wk, 4 wk, 12 wk, and 24 wk after RARP were 71.8%, 77.8%, 89.3%, 94.4%, and 98.0%, respectively. Multivariate analysis revealed that the nerve sparing technique, D'Amico risk groups, lymph node dissection, and prostate volume were involved in the early recovery of urinary continence. One ileal perforation requiring reoperation was recorded. The transfusion rate was 0.8%. Thirty-one (12.3%) postoperative complications were recorded up to 6 mo after surgery. Among these, eight acute urinary retentions (3.2%) and three urine leakages (1.2%) were recorded. There was a lack of randomization and comparison with other techniques. Both anatomical dissection of the prostatic apex and TAR were used. The results may not be generalized to low-volume centers. Conclusions: The TAR technique showed promising results in the early recovery of urinary continence, as well as watertight anastomosis and a low rate of urine leakage. The oncologic results were not affected. Comparative studies are needed to support the quality of reported results