Abstract
With the widespread use of imaging modalities performed for the staging of prostate cancer, the incidental detection of synchronous tumors is increasing in frequency. Robotic surgery represents a technical evolution in the treatment of solid tumors of the urinary tract, and it can be a valid option in the case of multi-organ involvement. We reported a case of synchronous prostate cancer and bifocal renal carcinoma in a 66-year-old male. We performed the first case of a combined upper- and lower-tract robotic surgery for a double-left-partial nephrectomy associated with radical prostatectomy by the transperitoneal approach. A comprehensive literature review in this field has also been carried out. Total operative time was 265 min. Renal hypotension time was 25 min. Blood loss was 250 mL. The patient had an uneventful postoperative course. No recurrence occurred after 12 months. In the literature, 10 cases of robotic, radical, or partial nephrectomy and simultaneous radical prostatectomy have been described. Robotic surgery provides less invasiveness than open surgery with comparable oncological efficacy, overcoming the limitations of the traditional laparoscopy. During robotic combined surgery for synchronous tumors, the planning of the trocars’ positioning is crucial to obtain good surgical results, reducing the abdominal trauma, the convalescence, and the length of hospitalization with a consequent cost reduction. Rare complications can be related to prolonged pneumoperitoneum. Simultaneous robotic prostatectomy and partial nephrectomy appears to be a safe and feasible surgical option in patients with synchronous prostate cancer and renal cell carcinoma.
Highlights
In 2018, 1,276,106 new cases of Prostate Cancer (PCa) and 403,262 new cases of kidney cancer were registered worldwide, representing 7.1% of all cancers in men and 2.2% in both sexes, respectively [1].In patients affected by PCa, the risk of having a synchronous tumor of the kidney and pelvis increases by 6.12 times compared to the general population [2]
The rate of detection of kidney cancer in patients who had been subjected to staging workup for PCa was significantly increased compared with that expected in the general population, with a Standardized Incidence Ratio (SIR) of 18.19 [3]
Surgical treatment of synchronous kidney cancer and PCa is performed in two stages, and the robotic approach has been established as safe and effective therapy for both tumors
Summary
In 2018, 1,276,106 new cases of Prostate Cancer (PCa) and 403,262 new cases of kidney cancer were registered worldwide, representing 7.1% of all cancers in men and 2.2% in both sexes, respectively [1]. The robotic approach invasiveness in the case of multi-organ treatment: it could be considered as an option to reduce the used in nephron sparing surgery helps to obtain a lower rate of conversion to open surgery and to length of hospital stays, patient anxiety, andtime, surgical burden [8,9]. The usefor of asimultaneous minimally invasive can make the solution safe, andcombined with less invasiveness in the case of multi-organ treatment: it could be considered surgeryeffective, growing, the robot-assisted surgery should be considered The aim of this as an option to reduce the length of hospital stays, patient anxiety, and surgical burden study was to report the case of robotic combined surgery as treatment for synchronous.
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