Alberto, Lapini

Campi, Riccardo

Mari, Andrea

Maria Rosaria Raspollini,

Minervini, Andrea

Serni, Sergio

Siena, Giampaolo

Tuccio, Agostino

English

Florence Research

between pre-eSRT PSA level and BCR-free survival rate at 5years after eSRT according to cancer characteristics at RP.Results: Median follow-up after eSRT was 47 months. The 5-year BCR-free survival rate was 81%. At multivariableanalysis, pre-eSRT PSA level was associated with BCR aftereSRT (hazard ratio (HR)=4.89; p<0.0001). Moreover,pathologic stage ≥pT3b (HR=2.07; p=0.007), pathologicGleason score ≥8 (HR=2.69; p=0.0002) and negative surgicalmargins (HR=2.50; p<0.0001) were associated with BCR andwere identified as risk factors. Overall, using lowess methods,we observed a decrease of 5-year BCR-free survival rate from87% to 75% for pre-eSRT PSA level ranging from 0.1ng/ml to0.5 ng/ml. Overall, the 5-year BCR risk increased by 3% per0.1 ng/ml of PSA level. However, when patients werestratified according to the number of risk factors (≤1 vs. ≥2),the effect of increasing PSA at eSRT on cancer control washigher in men with more aggressive disease. Specifically,patients with ≥2 pathologic risk factors showed a 5-yearincreased risk of BCR equal to 10% per 0.1 ng/ml of PSAlevel vs. 1.5% in patients with a single risk factor (p<0.001).Conclusion: Cancer control after eSRT depends onpretreatment PSA level. This effect is highest in men with, atleast, two of the following features: pT3b/pT4 disease,pathologic Gleason score ≥8 and negative surgical margins. Inthese patients, eSRT should be administered at the very firstsign of PSA increase in order to maximize cancer control.115ROBOT-ASSISTED LAPAROSCOPICVESICULECTOMY FOR LARGE SEMINALVESICLE CYSTOADENOMA: A CASE REPORT AND REVIEW OF THE LITERATURERiccardo Campi1, Maria Rosaria Raspollini2, Agostino Tuccio1, Andrea Mari1, Jacopo Frizzi1,Giampaolo Siena1, Sergio Serni1, Marco Carini1, Alberto Lapini1 and Andrea Minervini11Department of Urology, Careggi Hospital, University ofFlorence, Florence, Italy;2Department of Pathology, Cargo Hospital, University ofFlorence, Florence, ItalyANTICANCER RESEARCH 35: 3615-3740 (2015)3684Figure 1. (Abstract 115).Case Report: A 47-year-old patient was referred to our centrefor gross hematuria, mild dysuria and other lower urinary tractsymptoms (LUTS). Past medical history was unremarkable andno co-morbidities were present. Digital rectal examination(DRE) revealed, cranially to the prostate, a tense-elastic masswith undefined upper and lateral boundaries. Prostate-specificantigen (PSA) level was 1.7 ng/ml. Physical examination andlaboratory tests were otherwise normal. Trans-abdominalultrasound showed no lesions or abnormalities in the upperurinary tract; high-resolution trans-rectal ultrasound (TRUS)confirmed the presence of a multisepted, solid-cystic pelvic massoccupying the retrovesicle space. An office cystoscopy showedno lesions within the bladder. Pelvic magnetic resonanceimaging (MRI) confirmed the presence of a retrovesicle, 6.0×4.5Abstracts of the 25th Annual Meeting of the Italian Society of Uro-Oncology (SIUrO), 21-23 June, 2015, Rome, Italy3685Table I. Strategies for diagnosis and types of surgical approach for seminal vesicle cystoadenoma according to the published series. TRUS,transrectal ultrasound; CT, computed tomography; MRI, magnetic resonance imaging; CYS, cystoscopy; FNA, fine needle aspiration; AbdUS, abdominal ultrasound, RALV, robot-assisted laparoscopic vesiculectomy.Study Patient’s Tumor size Diagnostic Surgical Perioperative Local recurrence, age (greatest strategy procedure complication Y=present, (years) diameter) Y=present, N=absent (cm) N=absent (years after surgery)Soule et al. Proc Staff 47 14 Open N NMeet Mayo Clin., 1951. (Conservative)Damjanov et al. J Urol., 1974. 52 5.5 Autopsy N NLundhus et al. Scand J 39 7.4 Open N NUrol Nephrol., 1984. (Cysto-prostato-vesiculectomy)Mazur et al. Am Jour 49 7 Open N Y (2)of Surg Path 1987. (Conservative)Bullock et al. JR Soc Med., 1988. 59 12 LV N Y (3)Raghuveer et al. Indian J Pathol Microbiol., 1989.Mazzucchelli et al. J Urol., 1992. 63 3 Open N N(Conservative)Ranschaert et al. J Belge 50 12 Open N NRadiol., 1992. (Conservative)Lagalla et al. Abdom Imaging 1993. 33 TRUS, CT, FNA - Open N NCytology, Biopsy (Conservative)Santos et al Pathology., 2001. 49 15 Open N N(Conservative)Gil et al International Braz 49 7 Abd US, CT, MRI Open N NJ Urol., 2003. (Conservative,retrovesicle approach)Lee et al. Intern Jour  46 7.5 CT, MRI, Explorative Open N Nof Urol., 2006. Laparotomy (Conservative)Lorber et al Eur Urol., 2011. 52 14 CT, MRI, Abd Open N NUS, Biopsy (Conservative, transvesicle)Kural et al. Journ of Endourol., 2011. 48 6 TRUS, Biopsy RALV N NPloumidis et al. Intern Jour 45 17.2 TRUS, CT, MRI, CYS, RALV N Nof Surg Case Reports 2012. FNA-Cytology, Intra-operative BiopsyArora et al. Urology 2013. 23 TRUS, MRI Open N N(Conservative)Zhu et al. Asian Journ of 31 5 CT, MRI LV N NAndrology 2013. Zhang et al. Urology 2013. 32 5 LV N NZhang et al. Urology 2013. 64 4.5 LV N NZhang et al. Urology 2013. 50 3.8 LV N Ncm well-defined pseudo-nodular mass, arising from the rightseminal vesicle (SV) and vas deferens (VD) (Figure 1).TRUS-guided prostatic and SVs biopsies showed noneoplastic proliferation in all the samples from both theprostate and the mass. The patient was then scheduled forrobot-assisted laparoscopic vesiculectomy (RALV). After atransversal incision of the peritoneum at the level of theDouglas pouch, a voluminous mass, firmly adherent to thesurrounding tissues, was found. The plane between the mass,the rectum and the bladder was carefully developed until thetumor was completely released from the surroundingadhesions. The left VD and SV were preserved during thedissection. The neuro-vascular bundles (NVBs) wereapproached bilaterally in an athermal, traction-free manner inANTICANCER RESEARCH 35: 3615-3740 (2015)3686Figure 2. (Abstract 115).Figure 3. (Abstract 115).order to preserve continence and potency. The specimen wasthen removed intact through the camera port by using aretrieval bag. Accurate hemostatic control was achieved and atube drain was positioned. Console time and estimated bloodloss were, respectively, 120 minutes and 50 cc; nointraoperative complications were recorded. The post-operative course was uneventful and the patient wasdischarged on the fourth postoperative day with normal bloodtests and spontaneous voiding. A two-year follow-up showedno evidence of disease recurrence. At present, the patient isfree of symptoms with full preservation of continence andpotency. Histopathological examination revealed a7.0×4.5×4.5 cm cystic SV cystoadenoma (Figure 2). No significant cytologic atypia, mitotic activity or necrosiswere present. The proliferation index was <1%. Review ofthe Literature: A systematic review of the English-languageliterature was performed using the Medline, Embase andWeb of Science databases up to December 2014. Twentycase reports have been published in literature on SVcystoadenoma (Table I). Median patient age and median tumor diameter were 49years (inter-quartile range (IQR)=42-51) and 7.0 cm (IQR5.0-12.0), respectively. No perioperative complications werereported in all the published series. Local recurrenceoccurred in 2 cases (10%) after 2 and 3 years, respectively.The differential use of diagnostic investigations and surgicalapproaches for SV cystoadenoma in the published series isshown in Figure 3. Discussion and Conclusion: Primarytumors of SVs are very rare and the differential diagnosismust be based on a multimodality approach. Most cases ofSV cystoadenoma were managed with open surgery throughtransvesicle/retrovesicle approaches or radical cysto-prostato-vesiculectomy. To date, minimally-invasive seminalvesiculectomy (MISV) is increasingly used for the treatmentof beginning diseases of SVs achieving optimal oncologicand functional results. Therefore, they could be consideredthe new gold standard for the treatment of such rare diseases.116CURRENT STRATEGIES FOR DIAGNOSIS AND TREATMENT OF BENIGN TUMORS OF SEMINAL VESICLES: A SYSTEMATIC REVIEW OF THE LITERATURERiccardo Campi, Agostino Tuccio, Giampaolo Siena,Andrea Mari, Gianni Vittori, Michele Lanciotti, Andrea Cocci, Riccardo Fantechi, Andrea Chindemi,Tommaso Jaeger, Sergio Serni, Marco Carini, Alberto Lapini and Andrea MinerviniDepartment of Urology, Careggi Hospital, University ofFlorence, Florence, ItalyIntroduction/Aim: Benign tumors (BT) of seminal vesicles (SV)are very rare. Diagnosis could be challenging and often requiresthe histopathological analysis after surgical excision. The bestsurgical treatment is still matter of discussion. The aim of thisreview is to analyze the current strategies for diagnosis andtreatment of such tumors. Materials and Methods: A systematicreview of English literature was performed using the Medline,Embase and Web of Science databases up to October 2014. Useof diagnostic investigations, options of surgical management,perioperative complications rate and oncologic outcomes wereanalyzed for each tumor histotype. Results: Fifty-eight casereports have been published in literature on BTs of SVs (Table I).Of these, 5 were excluded from the analysis due to lack of data.Cystoadenoma was found in 20 cases (38%), leiomyoma in 10(19%), schwannoma in 8 (15%), mixed epithelial-stromal tumorin 5 (9%), phyllodes tumor in 4 (8%) and other BTs in 6 (11%)(Figure 1). Median patient age and median tumor diameter were50 years (range=23-79) and 5.0 cm (range=2.0-29.0),Abstracts of the 25th Annual Meeting of the Italian Society of Uro-Oncology (SIUrO), 21-23 June, 2015, Rome, Italy3687Figure 1. (Abstract 116).

ROBOT-ASSISTED LAPAROSCOPIC

VESICULECTOMY FOR LARGE SEMINAL

VESICLE CYSTOADENOMA: A CASE REPORT

AND REVIEW OF THE LITERATURE

https://flore.unifi.it/bitstream/2158/1056701/1/115.pdf

ROBOT-ASSISTED LAPAROSCOPIC VESICULECTOMY FOR LARGE SEMINAL VESICLE CYSTOADENOMA: A CASE REPORT AND REVIEW OF THE LITERATURE

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