Campi, Riccardo

Carini, Marco

Davide, Facchiano

Francesco, Sessa

Marco, Roscigno

Minervini, Andrea

Riccardo, Tellini

Serni, Sergio

Tommaso, Chini

English

Florence Research

12Department of Urology, Fundaciò Puigvert, Barcelona, Spain;13Department of Urology,  OLV Clinic, Aalst, Belgium;14Roland Van Velthoven Department of Urology, JulesBordet Institute, Bruxelles, BelgiumIntroduction/Aim: Current guidelines consider a positiveprostate biopsy (Bx) result as an important requirement inmen seeking to undergo salvage radical prostatectomy (sRP)after biochemical recurrence (BCR). However, results ofconfirmatory pre-sRP biopsy (cBx) have never beenreported in large contemporary cohorts. Our aim was toevaluate the detection rate of pre-sRP prostate Bx; toestablish the Gleason score (GS) concordance (Conc) ofcBx and first diagnostic biopsy (fBx) with the final sRPspecimen GS, respectively; to analyse the GS Conc betweenthe fBx and cBx GS. Materials and Methods: Weretrospectively collected data of 209 men who underwent sRPafter BCR at 10 European high-volume centres between 1991and 2015. Clinical and pathological features, including age,prostate-specific antigen (PSA), TNM, imaging and previoustreatments were recorded. FBx, cBx and sRP GS sums werecategorised in ≤6, 7, 8, 9 and 10. Men without appropriateinformation or undergoing sRP without an available cBxresult were excluded. Cohen’s Kappa coefficient was used forConc to consider inter-rater agreement. Detection rate andConc, upgrading (UpGr) and downgrading (DownGr) arereported as number of events and percentages. Results: Onehundred and sixty six men were included. Mean age, initialand pre-sRP PSA were 64.8±6.1 years, 19.6 and 8.7 ng/ml,respectively. Pathological stage of the sRP specimen was pT2in 43.7% and pT3 in 54.4%. Two cases were pT0 and no pT4were present. All had negative imaging for extra-nodalmetastasis. Sixty percent of the patients had hormone therapybefore sRP. CBx Detection rate was 89.8% (n=149) with theremaining 10.24% (n=17) having no prostate cancer diagnosisdue to radiation injury or absence of tumour being detected.Conc, UpGr and DownGr between cBx and sRP specimenswere 61.1% (n=88, k=0.208), 28.5% (n=41) and 10.4%(n=15). Five sRP specimens were not evaluable due toradiation injury or had no tumour. Conc, UpGr and DownGrbetween fBx and cBx were 48.9 (n=45, k=0.284), 43.8 (n=40)and 7.61 (n=7) (fBx missing n=57). Conc, UpGr and DownGrbetween fBx and sRP specimens were 36.7% (n=32,k=0.105), 55.1% (n=48) and 8.0% (n=7), respectively.Conclusion: Pre-sRP confirmatory biopsy has an appropriateability of confirming the presence of tumour. However, itunderestimates GS in a significant proportion of men,having a higher GS at the final histology of the sRPspecimen. The original diagnostic biopsy is not a reliablesource of GS information when planning second-linetreatment after BCR as it is upgraded in more than half ofthe cases.77ANATOMICAL LANDMARKS AND SURGICAL TEMPLATES OF LYMPH NODE DISSECTION FOR UPPER TRACT UROTHELIAL CARCINOMA: A SYSTEMATIC REVIEW OF THE LITERATURERiccardo Campi1, Andrea Minervini1, Andrea Mari1,Francesco Sessa1, Tommaso Chini1, Pietro Spatafora1,Riccardo Tellini1, Davide Facchiano1, Alberto Lapini1,Marco Roscigno2, Sergio Serni1 and Marco Carini11Department of Urology, University of Florence, Careggi Hospital, Florence, Italy, Firenze (FI), Italy;2Department of Urology, AO Papa Giovanni XXIII,Bergamo, ItalyIntroduction/Aim: Indications, techniques and outcomes oflymph node dissection (LND) for upper tract urothelialcarcinoma (UTUC) are still debated. Although potentialbenefits of LND have been described in literature,hesitancy and lack of standardization still exists evenamong academic institutions. The aim of the study was toprovide a comprehensive overview on anatomicallandmarks of LND for UTUC and propose evidence-basedtemplates according to the location of the primary tumor.Materials and Methods: A systematic review of theEnglish-language literature up to June 1, 2015, wasperformed using the Medline, Scopus and Web ofSciences databases according to the PRISMA criteria.Cohort studies providing detailed data on the surgicaltemplate of LND were included and analyzed. Results: Atotal of 702 articles were identified. After study selection,16 studies recruiting 1,705 patients were selected forreview and critically analyzed. Among these, most weresingle-centre, retrospective cohort studies, of which 2mapping studies. Sample size, tumor location and stagewere highly variable across the published series. An opensurgical approach was used in most cases. Nostandardized selection criteria for LND were followed,being LND performed at surgeon’s discretion and/or basedon pre/intraoperative suspicion of LN metastases. In moststudies, the extent of LND was not standardized. Anoverview of the LND templates according to the currentliterature are shown in Figure 1, while the proposedstandardized templates based on the available mappingstudies in Figure 2 (A-C). Discussion and Conclusion:Indications and templates of LND for UTUC are stillcontroversial. We have proposed standardized evidence-based templates to improve the quality of future clinicalseries. Further research is needed to validate thesetemplates to understand the exact patterns of lymphaticdrainage from UTUCs. ANTICANCER RESEARCH 36: 2535-2628 (2016)2594Abstracts of the 26th Annual Meeting of the Italian Society of Uro-Oncology (SIUrO), 9-11 June, 2016, Florence, Italy2595Figure 1. Schematic view of surgical anatomy (left picture) and critical sites of lymph node dissection (right picture) for upper tract urothelialcarcinoma. A, aorta; IVC, inferior vena cava; GV, gonadal vein; GA, gonadal artery; AB, aortic bifurcation; VCB, vena cava bifurcation; CIA,common iliac artery; EIA, external iliac artery; IIA, internal iliac artery; CIAB, common iliac artery bifurcation; RH, renal hilum; SMI,superior mesenteric artery; IMA, inferior mesenteric artery; Ki, kidney; Ad, adrenal; UB, urinary bladder. Figure 2. A: Anatomical templates of lymph node dissection (LND) according to laterality and location of the primary tumor based on acritical analysis of the current literature: LND templates for tumors of the renal pelvis and upper third of the ureter. RP, renal pelvis; UU,upper third of the ureter; MU, middle third of the ureter; LU, lower third of the ureter; LN, lymph node. ANTICANCER RESEARCH 36: 2535-2628 (2016)2596Figure 2. B: Anatomical templates of lymph node dissection (LND) according to laterality and location of the primary tumor based on a criticalanalysis of the current literature: LND templates for tumors of the middle third of the ureter.  RP, renal pelvis; UU, upper third of the ureter; MU,middle third of the ureter; LU, lower third of the ureter; LN, lymph node. C: Anatomical templates of lymph node dissection (LND) accordingto laterality and location of the primary tumor based on a critical analysis of the current literature: LND templates for tumors of the lower thirdof the ureter. RP, renal pelvis; UU, upper third of the ureter; MU, middle third of the ureter; LU, lower third of the ureter; LN, lymph node.

ANATOMICAL LANDMARKS AND SURGICAL TEMPLATES OF LYMPHNODE DISSECTION FOR UPPER

TRACT UROTHELIAL CARCINOMA: A SYSTEMATIC REVIEW OFTHE LITERATURE

https://flore.unifi.it/bitstream/2158/1056670/1/77.pdf

ANATOMICAL LANDMARKS AND SURGICAL TEMPLATES OF LYMPHNODE DISSECTION FOR UPPER TRACT UROTHELIAL CARCINOMA: A SYSTEMATIC REVIEW OFTHE LITERATURE

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