Outcomes of minimally invasive partial nephrectomy among very elderly patients: Report from the resurge collaborative international database

The aim of the study was to perform a comprehensive investigation of clinical outcomes of robot-assisted partial nephrectomy (RAPN) or laparoscopic partial nephrectomy (LPN) in elderly patients presenting with a renal mass.The REnal SURGery in Elderly (RESURGE) collaborative database was queried to identify patients aged 75 or older diagnosed with cT1-2 renal mass and treated with RAPN or LPN. Study outcomes were: overall complications (OC); warm ischemia time (WIT) and 6-month estimated glomerular filtration rate (eGFR); positive surgical margins (PSM), disease recurrence (REC), cancer-specific mortality (CSM) and other-cause mortality (OCM). Descriptive statistics, Kaplan-Meier, smoothed Poisson plots and logistic and linear regression models (MVA) were used.Overall, 216 patients were included in this analysis. OC rate was 34%, most of them being of low Clavien grade. Median WIT was 17 minutes and median 6-month eGFR was 54 ml/min/1.73 m(2). PSM rate was 5%. After a median follow-up of 20 months, the 5-year rates of REC, CSM and OCM were 4, 4 and 5%, respectively. At MVA predicting perioperative morbidity, RAPN relative to LPN (odds ratio [OR] 0.33; p <0.0001) was associated with lower OC rate. At MVA predicting functional outcomes, RAPN relative to LPN was associated with shorter WIT (estimate [EST]-4.09; p <0.0001), and with higher 6-month eGFR (EST 6.03; p = 0.01).In appropriately selected patients with small renal masses, minimally-invasive PN is associated with acceptable perioperative outcomes. The use of a robotic approach over a standard laparoscopic approach can be advantageous with respect to clinically relevant outcomes, and it should be preferred when available

Robotic radical prostatectomy: a critical analysis of the impact on cancer control.

PURPOSE OF REVIEW: Robot-assisted laparoscopic prostatectomy (RALP) has become the most used surgical procedure to treat clinically localized prostate cancer. Considering its curative intent, the evaluation of the oncologic outcomes must be considered with careful attention. In this review, we summarized and critically discussed the most relevant oncologic data available in the literature about RALP. RECENT FINDINGS: Currently, the oncologic effectiveness of RALP procedure can be evaluated looking at surrogate end-points such as positive surgical margins rate, percentage of additional salvage therapies required, and biochemical disease-free survival (bDFS). Available studies comparing RALP and retropubic radical prostatectomy showed that positive surgical margin rates were equivalent or slightly lower following RALP. Moreover, population-based studies showed similar risk in terms of additional salvage therapies between retropubic radical prostatectomy and minimally invasive radical prostatectomy. Moreover, comparative studies with short-term follow-up demonstrated overlapping results also in terms of bDFS. The initial long-term oncologic data (5-year median follow-up) estimated excellent 5-year and 7-year bDFS probabilities after RALP. SUMMARY: Although further studies with long-term follow-up are needed to estimate the main oncologic outcomes (overall and cancer-specific survival), available data supported the oncologic safety of RALP procedure in patients with clinically organ-confined prostate cancer

Robot-Assisted Cystectomy: Strengths and Weaknesses

Introduction: In recent years, minimally invasive techniques such as purely robot-assisted radical cystectomy (RARC) have been suggested as a new surgical approach to muscle-invasive bladder cancer. In this article we review the review the intra-and perioperative results as well as the short-and intermediate-term oncologic results of RARC. Materials and methods: Based on the work recently presented at the European Society of Oncological Urology's 2011 meeting, we reviewed the available literature on RARC. A PubMed literature search was conducted in March 2011 to review English-language articles published from 2000 onward on RARC. Results: The literature supports that lymph node yield, learning curve, and intermediate-term oncologic outcomes related to RARC are not different from open surgery. Several articles described the advantages of robotic approach in terms of estimated blood loss, hospital stay, and perioperative outcomes. Operative time remains significantly longer than in the open procedure. A low rate of positive surgical margins may be achieved with RARC, comparable with the open approach. Intracorporeal urinary diversion is likely to represent the future direction for RARC, even if it requires great technical expertise. Due to the relatively recent introduction of the robotic approach in the bladder cancer arena, long-term oncologic data are not yet available. Conclusions: RARC represents a safe and viable treatment for muscle-invasive bladder cancer. However, there is an urgent need for large, prospective, randomised trials that will establish the potential advantages and limitation of RARC compared with the open approach. (C) 2011 Published by Elsevier B.V. on behalf of European Association of Urology