Alberto, Lapini

Alessandro, Antonelli

Alessandro, Volpe

Alexander, Kutikov

Brian, Lane

Bulen, Akdogan

Carini, Marco

Christian Villeda sandoval,

Francesco, Sanguedolce

Georgios, Hatzichristodoulou

Hans, Langenhuijsen

Marco, Roscigno

Mari, Andrea

Martin, Marszalek

Minervini, Andrea

Nihat, Karakoyunlu

Oscar Rodriguez faba,

Ottavio De Cobelli,

Riccardo, Campi

Sabine Brookman may,

Tobias, Klatte

Umberto, Capitanio

Uzzo, Robert G.

English

Florence Research

tumors, keratin, EMA, vimentin and CEA and, sometimes,hCG. Additional immunohistochemistry was adopted whenrequired to improve the pathological diagnosis. Candidatepatients to cystectomy, for reason other than large bladder tumorwith radiologic imaging suggestive of bladder wall infiltration,i.e. Tis, multiple and/or recurrent non muscle invasive andpatients submitted to TURBT at other centers, were excluded.Inferential statistical analysis was performed. Results: Out of340 patients, 35 (10.3%) showed rare histotypes of bladdercancer, i.e. in 30 cases (32%) out of 94 radical cystectomies andin 5 (2%) out of 246 TURBTs. The rare histotypes weredistributed as follows: squamous carcinoma 11 (31%),sarcomatoid 8 (23%), undifferentiated 6 (17%), neuroendocrine3 (9%), micropapillary 2 (6%), adenocarcinoma 1 (3%), mixed4 (11%). TCCB with histological rare variants showed atcystectomy considerable size (average diameter=7.7×6.7 cm;range=4.5×5-11×9 cm), while 13 (43%) were pT4 category. In13 patients (37%), the uncommon histotype was detected at thepre-operative TURBT, while, in 22 (63%), it was recognizedonly in the cystectomy specimen. Regarding the correlationbetween TURBT and re-TUR, rare histotypes were notidentified at the first TURBT in 9 patients (26%) but found atre-TURBT in 4 patients (44%) and at cystectomy in 5 patients(56%) (Figure 1). Conversely, an atypical component diagnosedat first TURBT was not confirmed by a subsequent re-TUR inonly 1 patient (3%). Discussion: Although the importantprognostic role of rare histologic variants of bladder cancer iswell-recognized, TURBT is not standardized in relation totumor size. Unrecognized rare histotypes might have importanttherapeutic implications since they are probably less responsiveto neoadjuvant chemotherapy or bladder-sparing approaches,thus benefiting early cystectomy. The inaccuracy of TUR ineveryday clinical practice in detecting uncommon variants couldbe explained by the inadequacy of sampling of large tumors.The “pre-cystectomy” TUR is often considered a limited biopsyto confirm the tumor and to demonstrate the infiltration of themuscular layer. As a matter of fact, pathologists often do notanalyze a sufficient amount of tissue to identify differenthistological components. Standardization of the TURBTstrategy, including sampling of different areas of bulky tumors,could be of clinical value.Figure 1. Flow chart showing the correlation between TURBT, re-TUR and cystectomy.84PREDICTIVE FACTORS OF RESECTIONTECHNIQUES DURING PARTIAL NEPHRECTOMYIN A COHORT OF “ENUCLEORESECTIVE”CENTERS: INSIGHTS FROM THE SURFACE-INTERMEDIATE-BASE (SIB) MARGIN SCOREINTERNATIONAL CONSORTIUMAndrea Minervini1, Riccardo Campi1, Andrea Mari1, Ottavio De Cobelli2, Francesco Sanguedolce3, Christian Villeda-sandoval3, Georgios Hatzichristodoulou4,Alessandro Antonelli5, Brian Lane6, Bulent Akdogan7,Umberto Capitanio8, Martin Marszalek9, Alessandro Volpe10,Nihat Karakoyunlu11, Hans Langenhuijsen12, Tobias Klatte13,Oscar Rodriguez-faba14, Sabine Brookman-may15, Marco Roscigno16, Robert G Uzzo17, Alberto Lapini1, Marco Carini1 and Alexander Kutikov171Department of Urology, University of Florence, CareggiHospital, Florence, Italy, Firenze (FI), Italy;2Department of Urology, European Institute of Oncology (IEO), Milan, Italy;3Department of Urology, Southmead Hospital-North Bristol NHS Trust, Bristol, U.K.;4Department of Urology, Technical University of Munich,University Hospital Klinikum Rechts Der Isar, §Munich, Germany;5Department of Urology, University of Brescia, Brescia, Italy;6Department of Urology, Spectrum Health Cancer Center, Grand Rapids, MI, U.S.A.;7Department of Urology, Hacettepe University, School of Medicine, Ankara, Turkey;8Department of Urology, Vita-Salute San RaffaeleUniversity, IRCCS San Raffaele Scientific Institute, Milan, Italy;9Department of Urology and Andrology, Donauspital, Vienna, Austria;10Department of Urology, Maggiore Della Carità Hospital,University of Eastern Piedmont, Novara, Italy;11Department of Urology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey;12Department of Laparoscopy, Robotics and Endourology,Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands;13Department of Urology, Medical University of Vienna, Vienna, Austria;14Uro-Oncology Unit, Fundacio Puigvert, Barcelona, Spain;15Department of Urology, Ludwig Maximilians University, Munich, Germany;16Department of Urology, AO Papa Giovanni XXIII,Bergamo, Italy;17Division of Urologic Oncology, Fox Chase Cancer Center,Philadelphia, PA, U.S.A.ANTICANCER RESEARCH 36: 2535-2628 (2016)2602Introduction: Detailed reporting of resection strategies (RS)and resection techniques (RT) for tumor excision during partialnephrectomy (PN) is lacking in the current literature. The aimof the study was to evaluate (i) possible correlations betweenpatients’ and/or tumors’ characteristics and RT performed and(ii) whether the type of RT does influence perioperativeoutcomes after PN, harnessing the newly proposed Surface-Intermediate-Base (SIB) margin score as a standardizedreporting system. Materials and Methods: After InstitutionalReview Board’s approval, data were prospectively collectedfrom a cohort of 507 patients undergoing NSS at 16 high-volume Centers across the U.S. and Europe over a 6-monthenrollment period. RT was classified according to the SIBscore. RS was classified as “enucleative”, “enucleoresective”or “resective” according to the most prevalent RT performedin each centre’s cohort. Descriptive and comparative analyseswere performed in the six enucleoresective RS centres (ERC).Results: Overall, 507 patients were finally enrolled in the study.The RT was classified as pure or hybrid enucleation (E, SIB 0-2), pure or hybrid enucleoresection (ER, SIB 3-4) and resection(R, SIB 5) in 266 (52.5%), 150 (29.6%) and 91(17.9%)patients, respectively, in the overall cohort, while in 53(33.1%), 83 (51.9%) and 24 (15.0%) patients in the ERC.Demographic data, comorbidity scores, surgical indication andapproach and PADUA score did not significantly differbetween the E, ER and R groups in the ERC. Tumors >4.0 cmwere 21 (40.4%), 41 (49.4%) and 4 (16.7%) in the E, ER andR groups (p=0.02), respectively. A clampless strategy was usedin 19.2%, 13.2% and 8.3% of patients (p>0.05). Median warmischemia time (WIT) was 19 (15-24), 17 (14-23) and 17 (15-21) minutes in the E, ER and R groups (p>0.05). Surgical post-operative complications were recorded in 7.5%, 13.2% and4.2% of patients (p=0.05). Positive surgical margin rate was7.0%, 13.4% and 0% of patients, respectively (p>0.05).Trifecta outcome was achieved in 67.2%, 71.6% and 73.7% ofpatients for the E, ER and R groups (p>0.05). Discussion andConclusions: This is the first study evaluating pre-operativepredictive factors of RTs performed during PN and whether thetype of RT significantly impacts on NSS outcomes using astandardized instrument of reporting. Overall, in ERC, ERrepresents less than 52%. ER and E are performed in asignificantly higher proportion of tumors >4 cm compared toR. Relating to surgical outcomes, ER was associated with asignificantly higher rate of post-operative surgical complicationcompared to E and R. However, Trifecta achievement wascomparable among the three techniques.85RESECTION TECHNIQUES FOR NEPHRONSPARING SURGERY VARY: INSIGHTS FROM APROSPECTIVELY COLLECTED MULTI-INSTITUTIONAL COHORT HARNESSING THESURFACE-INTERMEDIATE-BASE (SIB) MARGINSCORE (SIB INTERNATIONAL CONSORTIUM)Andrea Minervini1, Riccardo Campi1, Andrea Mari1, Ottavio De Cobelli2, Francesco Sanguedolce3, Georgios Hatzichristodoulou4, Alessandro Antonelli5, Brian Lane6, Bulent Akdogan7, Umberto Capitano8, Martin Marszalek9, Alessandro Volpe10, Nihat Karakoyunlu11, Hans Langenhuijsen12, Tobias Klatte13, Oscar Rodriguez-faba14, Sabine Brookman-may15, Marco Roscigno16, Robert G. Uzzo17, Alberto Lapini1, Marco Carini1 and Alexander Kutikov171Department of Urology, University of Florence, CareggiHospital, Florence, Italy, Firenze (FI), Italy;2Department of Urology, European Institute of Oncology (IEO), Milan, Italy;3Department of Urology, Southmead Hospital-North Bristol NHS Trust, Bristol, U.K.;4Department of Urology, Technical University of Munich,University Hospital Klinikum Rechts Der Isar, Munich, Germany;5Department of Urology, University of Brescia, Brescia, Italy;6Department of Urology, Spectrum Health Cancer Center, Grand Rapids, MI, U.S.A.;7Department of Urology, Hacettepe University, School of Medicine, Ankara, Turkey;8Department of Urology, Vita-Salute San RaffaeleUniversity, IRCCS San Raffaele Scientific Institute, Milan, Italy;9Department of Urology and Andrology, Donauspital, Vienna, Austria;10Department of Urology, Maggiore Della Carità Hospital,University of Eastern Piedmont, Novara, Italy;11Department of Urology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey;12Department of Laparoscopy, Robotics and Endourology,Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands;13Department of Urology, Medical University of Vienna, Vienna, Austria;14Department of Urology, Fundacio Puigvert, Barcelona, Spain;15Department of Urology, Ludwig Maximilians University, Munich, Germany;16Department of Urology, AO Papa Giovanni XXIII, Bergamo, Italy;17Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, U.S.A.Introduction/Aim: Resection methodology is rarely reported incurrent nephron-sparing surgery (NSS) literature. Yet, aAbstracts of the 26th Annual Meeting of the Italian Society of Uro-Oncology (SIUrO), 9-11 June, 2016, Florence, Italy2603

PREDICTIVE FACTORS OF RESECTION TECHNIQUES DURING PARTIAL NEPHRECTOMY

IN A COHORT OF &#8220;ENUCLEORESECTIVE&#8221; CENTERS: INSIGHTS FROM THE SURFACEINTERMEDIATE-

BASE (SIB) MARGIN SCORE INTERNATIONAL CONSORTIUM

https://flore.unifi.it/bitstream/2158/1056674/1/84.pdf

PREDICTIVE FACTORS OF RESECTION TECHNIQUES DURING PARTIAL NEPHRECTOMY IN A COHORT OF “ENUCLEORESECTIVE” CENTERS: INSIGHTS FROM THE SURFACEINTERMEDIATE- BASE (SIB) MARGIN SCORE INTERNATIONAL CONSORTIUM

Abstract

Similar works

Full text

Available Versions

Florence Research

PREDICTIVE FACTORS OF RESECTION TECHNIQUES DURING PARTIAL NEPHRECTOMY IN A COHORT OF &#8220;ENUCLEORESECTIVE&#8221; CENTERS: INSIGHTS FROM THE SURFACEINTERMEDIATE- BASE (SIB) MARGIN SCORE INTERNATIONAL CONSORTIUM

Abstract

Similar works

Full text

Available Versions

Florence Research

PREDICTIVE FACTORS OF RESECTION TECHNIQUES DURING PARTIAL NEPHRECTOMY IN A COHORT OF “ENUCLEORESECTIVE” CENTERS: INSIGHTS FROM THE SURFACEINTERMEDIATE- BASE (SIB) MARGIN SCORE INTERNATIONAL CONSORTIUM