Medium-term Oncological Outcomes Research Articles

Evaluating bacterial contamination and surgical site infection risks in intracorporeal anastomosis: Role of bowel preparation.

We recently read the study by Kayano et al on intracorporeal anastomosis (IA) for colon cancer, which assessed bacterial contamination and medium-term oncological outcomes and affirmed that IA is analogous to extracorporeal anastomosis in reducing intraperitoneal bacterial risk and achieving similar oncological results. Our commentary addresses gaps, particularly concerning bowel preparation and surgical site infections (SSIs), and highlights the need for comprehensive details on the bowel preparation methods that are currently employed, including mechanical bowel preparation, oral antibiotics (OA), their combination, and specific OA types. We emphasize the necessity for further analyses that investigate these methods and their correlation with SSI rates, to enhance clinical protocol guidance and optimize surgical outcomes. Such meticulous analyses are essential for refining strategies to effectively mitigate SSI risk in colorectal surgeries.

Evaluation of bacterial contamination and medium-term oncological outcomes of intracorporeal anastomosis for colon cancer: A propensity score matching analysis.

Although intracorporeal anastomosis (IA) for colon cancer requires longer operative time than extracorporeal anastomosis (EA), its short-term postoperative results, such as early recovery of bowel movement, have been reported to be equal or better. As IA requires opening the intestinal tract in the abdominal cavity under pneumoperitoneum, there are concerns about intraperitoneal bacterial infection and recurrence of peritoneal dissemination due to the spread of bacteria and tumor cells. However, intraperitoneal bacterial contamination and medium-term oncological outcomes have not been clarified. To clarify the effects of bacterial and tumor cell contamination of the intra-abdominal cavity in IA. Of 127 patients who underwent laparoscopic colon resection for colon cancer from April 2015 to December 2020, 75 underwent EA (EA group), and 52 underwent IA (IA group). After propensity score matching, the primary endpoint was 3-year disease-free survival rates, and secondary endpoints were 3-year overall survival rates, type of recurrence, surgical site infection (SSI) incidence, number of days on antibiotics, and postoperative biological responses. Three-year disease-free survival rates did not significantly differ between the IA and EA groups (87.2% and 82.7%, respectively, P = 0.4473). The 3-year overall survival rates also did not significantly differ between the IA and EA groups (94.7% and 94.7%, respectively; P = 0.9891). There was no difference in the type of recurrence between the two groups. In addition, there were no significant differences in SSI incidence or the number of days on antibiotics; however, postoperative biological responses, such as the white blood cell count (10200 vs 8650/mm3, P = 0.0068), C-reactive protein (6.8 vs 4.5 mg/dL, P = 0.0011), and body temperature (37.7 vs 37.5 °C, P = 0.0079), were significantly higher in the IA group. IA is an anastomotic technique that should be widely performed because its risk of intraperitoneal bacterial contamination and medium-term oncological outcomes are comparable to those of EA.

A novel technique of reverse-sequence endoscopic nipple-sparing mastectomy with direct-to-implant breast reconstruction: medium-term oncological safety outcomes and feasibility of 24-h discharge for breast cancer patients.

Due to the short operation time and no need for special instruments, reverse-sequence endoscopic nipple-sparing mastectomy (R-E-NSM) with direct-to-implant breast reconstruction (DIBR) has been rapidly becoming popular in the last three years. However, there has yet to be an evaluation of its oncologic safety or the feasibility of discharging patients within 24 h. In this single-centre retrospective cohort study, individuals diagnosed with stage 0-III breast cancer between May 2020 and April 2022 who underwent traditional open mastectomy or R-E-NSM with DIBR were included. Follow-up started on the date of surgery and ended in December 2023. Data, including demographics, tumour characteristics, medium-term oncological outcomes, and postoperative complications, were collected and analyzed. Propensity score matching (PSM) was performed to minimize selection bias. This study included 1679 patients [median (IQR) age, 50 [44-57) years]. Of these, 344 patients underwent R-E-NSM with DIBR (RE-R group), and 1335 patients underwent traditional open mastectomy (TOM group). The median [IQR] follow-up time was 30 [24-36] months [29 (23-33) months in the RE-R group and 30([24-36) months in the TOM group]. Regarding before or after PSM, the P value of local recurrence-free survival (LRFS, 0.910 and 0.450), regional recurrence-free survival (RRFS, 0.780 and 0.620), distant metastasis-free survival (DMFS, 0.061 and 0.130), overall survival (OS, 0.260 and 0.620), disease-free survival (DFS, 0.120 and 0.330) were not significantly different between the RE-R group and the TOM group. The 3y-LRFS and 3y-DFS rates were 99.0% and 97.1% for the RE-R group and 99.5% and 95.3% for the TOM group, respectively. The rates of any complications and major complications were not significantly different between the RE-R patients who were discharged within 24 h and the RE-R patients who were not discharged within 24 h ( P =0.290, P =0.665, respectively) or the TOM patients who were discharged within 24 h ( P =0.133, P =0.136, respectively). R-E-NSM with DIBR is an innovative oncologic surgical procedure that not only improves cosmetic outcomes but also ensures reliable oncologic safety and fewer complications, enabling patients to be safely discharged within 24 h. A long-term prospective multicenter assessment will be supporting.

Stent as bridge to surgery decreases postoperative complications without worsening oncological outcomes: retrospective unicentric cohort study and stent placement protocol.

Even if the use of stent as bridge to surgery (BTS) for obstructive colon cancer was described long ago, there is still much controversy on their use. Patient recovery before surgery and colonic desobstruction are just some of the reasons to defend this management that can be found in several available articles. This is a single-center, retrospective cohort study, including patients with obstructive colon cancer treated between 2010 and 2020. The primary aim of this study is to compare medium-term oncological outcomes (overall survival, disease-free survival) between stent as BTS and ES groups. The secondary aims are to compare perioperative results (in terms of approach, morbidity and mortality, and rate of anastomosis/stomas) between both groups and, within the BTS group, analyze whether there are any factors that may influence oncological outcomes. A total of 251 patients were included. Patients belonging to the BTS cohort presented a higher rate of laparoscopic approach, required less intensive care management, less reintervention, and less permanent stoma rate, when comparing with patients who underwent urgent surgery (US). There were not significant differences in terms of disease-free survival and overall survival between the two groups. Lymphovascular invasion negatively affected oncological results but was not related with stent placement. The stent as a bridge to surgery is a good alternative to urgent surgery, which leads to a decrease in postoperative morbidity and mortality without significantly worsening oncological outcomes.

MP73-11 MEDIUM TERM OUTCOMES FOLLOWING PRIMARY FOCAL CRYOTHERAPY FOR LOCALISED PROSTATE CANCER IN 323 PATIENTS, A MULTI-INSTITUTIONAL OBSERVATIONAL STUDY OVER 10 YEARS

You have accessJournal of UrologyCME1 Apr 2023MP73-11 MEDIUM TERM OUTCOMES FOLLOWING PRIMARY FOCAL CRYOTHERAPY FOR LOCALISED PROSTATE CANCER IN 323 PATIENTS, A MULTI-INSTITUTIONAL OBSERVATIONAL STUDY OVER 10 YEARS Deepika Reddy, Max Peters, Marieke Van Son, Mariana Bertoncelli Tanaka, Philipp Huber, Derek Lomas, Arnas Rakauskas, Saiful Miah, David Eldred-Evans, Emma Cullen, Tim Dudderidge, Stuart McCracken, Damian Greene, Raj Nigam, Neil McCartan, Massimo Valerio, Clement Orczyk, Jaspal Virdi, Manit Arya, Taimur Shah, and Hashim Ahmed Deepika ReddyDeepika Reddy More articles by this author , Max PetersMax Peters More articles by this author , Marieke Van SonMarieke Van Son More articles by this author , Mariana Bertoncelli TanakaMariana Bertoncelli Tanaka More articles by this author , Philipp HuberPhilipp Huber More articles by this author , Derek LomasDerek Lomas More articles by this author , Arnas RakauskasArnas Rakauskas More articles by this author , Saiful MiahSaiful Miah More articles by this author , David Eldred-EvansDavid Eldred-Evans More articles by this author , Emma CullenEmma Cullen More articles by this author , Tim DudderidgeTim Dudderidge More articles by this author , Stuart McCrackenStuart McCracken More articles by this author , Damian GreeneDamian Greene More articles by this author , Raj NigamRaj Nigam More articles by this author , Neil McCartanNeil McCartan More articles by this author , Massimo ValerioMassimo Valerio More articles by this author , Clement OrczykClement Orczyk More articles by this author , Jaspal VirdiJaspal Virdi More articles by this author , Manit AryaManit Arya More articles by this author , Taimur ShahTaimur Shah More articles by this author , and Hashim AhmedHashim Ahmed More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003341.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Early outcomes following focal cryotherapy have demonstrated oncological and clinical safety. We report on the largest observational series from 7 centres across the UK. METHODS: 323 patients treated between June 2004- August 2021 with at least 12 months follow up recorded into the International Cryotherapy Evaluation registry were evaluated for safety and oncological outcomes. Kaplan Meier estimates were used to determine the Failure Free Survival (FFS), defined as avoidance of third ablative therapy, salvage whole gland or systemic therapy, prostate cancer metastases or prostate cancer specific death. Adverse events (AE) were reported according to the Clavien-Dindo classification. RESULTS: Median (IQR) follow up was 35 (20-52) months, median patient age was 68 (63-73) years. 174 (54%) patients and 144 (45%) had D’Amico intermediate, and high-risk disease respectively. Neoadjuvant ADT was prescribed in 33 (10%) of cases, quadrant ablation performed in 113 (35%), hemiablation in 194 (60%) and hockey-stick ablation in 16 (5%). FFS at 6.5 years was 71% (95% CI 59-80%); D’Amico intermediate 66% (95%CI 44-81%) and high risk 73% (59-84%), p=0.80 (Figure 1 & 2). 25 (8%) reported an AE with 5 UTIs, 1 epididymo-orchitis, 1 prostatic abscess (conservatively managed) and 1 sepsis event resulting in the only Clavien-Dindo 3 event. There were no rectal injuries. CONCLUSIONS: To our knowledge, this largest study reporting outcomes following primary focal cryotherapy, demonstrates good medium-term oncological outcomes with 99% having intermediate and high risk cancer. There were low rates of adverse events. Our data supports focal therapy as part of the counselling of options for treatment of localised clinically significant prostate cancer. Source of Funding: n/a © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1039 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Deepika Reddy More articles by this author Max Peters More articles by this author Marieke Van Son More articles by this author Mariana Bertoncelli Tanaka More articles by this author Philipp Huber More articles by this author Derek Lomas More articles by this author Arnas Rakauskas More articles by this author Saiful Miah More articles by this author David Eldred-Evans More articles by this author Emma Cullen More articles by this author Tim Dudderidge More articles by this author Stuart McCracken More articles by this author Damian Greene More articles by this author Raj Nigam More articles by this author Neil McCartan More articles by this author Massimo Valerio More articles by this author Clement Orczyk More articles by this author Jaspal Virdi More articles by this author Manit Arya More articles by this author Taimur Shah More articles by this author Hashim Ahmed More articles by this author Expand All Advertisement PDF downloadLoading ...

MP73-19 FOCAL CRYOABLATION VS FOCAL HIGH INTENSITY FOCUSED ULTRASOUND FOR INTERMEDIATE AND HIGH-RISK PROSTATE CANCER

You have accessJournal of UrologyCME1 Apr 2023MP73-19 FOCAL CRYOABLATION VS FOCAL HIGH INTENSITY FOCUSED ULTRASOUND FOR INTERMEDIATE AND HIGH-RISK PROSTATE CANCER Masatomo Kaneko, Alireza Ghoreifi, Samuel Peretsman, Jessica Cummins, Lorenzo Storino Ramacciotti, Giovanni E. Cacciamani, Amir H. Lebastchi, Suzanne L. Palmer, Manju Aron, Osamu Ukimura, Duke Bahn, Inderbir Gill, and Andre Luis Abreu Masatomo KanekoMasatomo Kaneko More articles by this author , Alireza GhoreifiAlireza Ghoreifi More articles by this author , Samuel PeretsmanSamuel Peretsman More articles by this author , Jessica CumminsJessica Cummins More articles by this author , Lorenzo Storino RamacciottiLorenzo Storino Ramacciotti More articles by this author , Giovanni E. CacciamaniGiovanni E. Cacciamani More articles by this author , Amir H. LebastchiAmir H. Lebastchi More articles by this author , Suzanne L. PalmerSuzanne L. Palmer More articles by this author , Manju AronManju Aron More articles by this author , Osamu UkimuraOsamu Ukimura More articles by this author , Duke BahnDuke Bahn More articles by this author , Inderbir GillInderbir Gill More articles by this author , and Andre Luis AbreuAndre Luis Abreu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003341.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To assess outcomes of focal Cryoablation (CRYO) and focal High Intensity Focused Ultrasound (HIFU) for Intermediate to high-risk prostate cancer (PCa). METHODS: Consecutive patients who underwent hemi-gland CRYO (h-CRYO) or hemi-gland HIFU (h-HIFU) as primary treatment for D’Amico intermediate risk and high-risk PCa were identified (IRB# HS-17-00749). Patients were followed by prostate biopsy (PBx) 6-12 mo and every 2 yr thereafter. The primary endpoint was treatment failure (TF) defined as Grade Group (GG) ≥2 on follow-up (FU) PBx, any whole-gland treatment, systemic therapy, metastases, or PCa-specific mortality. Secondary endpoints included survival-free from i) biochemical failure (BF, PSA nadir+2 ng/mL); ii) GG≥2 on FU-PBx, and iii) radical treatment. Kaplan-Meier and Cox regression analyses were performed for survival evaluation. International Prostate Symptom Score (IPSS), and International Index of Erectile Function (IIEF-5) were evaluated. Statistically significant if p<0.05. RESULTS: A total of 294 patients met the inclusion criteria: 192 (65%) CRYO and 102 (35%) HIFU. The baseline characteristics were comparable between h-CRYO vs h-HIFU, as follows: median age (68 vs 66yr, p=0.2), PSA (6.6 vs 6.1 ng/mL, p=0.08), PSA density (PSAD, 0.17 vs 0.16 ng/mL2, p=0.6), respectively. The distribution of GG for h-CRYO vs h-HIFU were as follows: GG1 (7.3% vs 2.0%), GG2-3 (77% vs 93%), and GG4-5 (15% vs 5.0%) (p<0.004), respectively. The median FU was longer for h-CRYO (46 mo) vs h-HIFU (22 mo); p<0.001. The 3-year TF-free survival was: 86% for h-CRYO and 62% for h-HIFU, p=0.003. PSAD per 0.01 was an independent predictor of TF on multivariate Cox regression analysis (hazard ratio [HR] 1.02, 95% confidence interval [95%CI] 1.01-1.03), but h-HIFU vs h-CRYO was not (HR 1.27, 95%CI 0.69-2.33). The 3-year free survival were, for h-CRYO vs h-HIFU: BF (75% vs 81%, p=0.76); GG≥2 on FU-PBx (88% vs 62%, p<0.001), and radical treatment (97% vs 83%, p=0.1), respectively. PSAD per 0.01 and the number of cancer cores on baseline PBx were independent predictors of GG≥2 on FU-PBx, but h-HIFU vs h-CRYO was not (HR 1.34, 95%CI 0.72-2.48). The median difference from pre- to post-FT IPSS (0 vs 1; p=0.27) was similar for h-CRYO vs h-HIFU, respectively. The median IIEF-5 decreased more after CRYO than HIFU (2 vs 0; p=0.005). Continence (zero pad) was maintained in 97% for h-CRYO and in 97% for h-HIFU (p=1.00). CONCLUSIONS: Hemi-gland CRYO and HIFU provide comparable and acceptable medium-term oncologic outcomes for intermediate-high risk PCa, with excellent functional outcomes. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1043 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Masatomo Kaneko More articles by this author Alireza Ghoreifi More articles by this author Samuel Peretsman More articles by this author Jessica Cummins More articles by this author Lorenzo Storino Ramacciotti More articles by this author Giovanni E. Cacciamani More articles by this author Amir H. Lebastchi More articles by this author Suzanne L. Palmer More articles by this author Manju Aron More articles by this author Osamu Ukimura More articles by this author Duke Bahn More articles by this author Inderbir Gill More articles by this author Andre Luis Abreu More articles by this author Expand All Advertisement PDF downloadLoading ...

Medium-term oncological outcomes of intermediate-risk prostate cancer treated with HIFU or cryotherapy. A single center 10-year experience.

Focal therapies (FTs) are promising techniques for the treatment of localized prostate cancer. We assessed the medium-term oncological outcomes of intermediate-risk prostate cancer (PCa) treated with HIFU or cryotherapy. One-hundred and fifty consecutive patients with intermediate-risk PCa, treated between 2009 and 2018 at a single center were included. Primary study outcome was failure-free survival (FFS), defined as absence of additional treatment, systemic progression or prostate cancer related death. Thirty-seven (25%) patients underwent cryotherapy and 113 (75%) HIFU. Median age was 69 (IQR 62-72) years, with 36 (24%) presenting palpable disease on rectal examination, and median total PSA of 7.85 (IQR 5.75-10.62) ng/mL. Patients were followed for a median of 61 (IQR 48-82) months. FFS at 2 and 4 years was of 75.6% and 53.6%, respectively. Survival from whole gland or systematic treatment at 2 and 4 years was of 78.9% and 53.9%, respectively. Patients with FFS presented lower total PSA nadir (1.89 vs 3.25 ng/mL, p < 0.001), higher % PSA reduction at 3 months (66.1% vs 49.3%, p < 0.001), and at nadir (75.5% vs 55.8%, p < 0.001). Other characteristics such has the treatment modality, age, prostate size, initial total PSA, cT stage, International Society of Urological Pathology (ISUP), tumor location and biopsy results by region did not differ between patients failing and not failing FT. Complications were uncommon (13%), with only onr (1%) patient having Clavien-Dindo grade > II. No deaths due to treatment were registered. At medium-term, FTs for intermediate-risk PCa presented good oncological results, with an excellent safety profile.

The Association of Tissue Change and Treatment Success During High-intensity Focused Ultrasound Focal Therapy for Prostate Cancer

BackgroundTissue preservation strategies have been increasingly used for the management of localized prostate cancer. Focal ablation using ultrasound-guided high-intensity focused ultrasound (HIFU) has demonstrated promising short and medium-term oncological outcomes. Advancements in HIFU therapy such as the introduction of tissue change monitoring (TCM) aim to further improve treatment efficacy. ObjectiveTo evaluate the association between intraoperative TCM during HIFU focal therapy for localized prostate cancer and oncological outcomes 12 mo afterward. Design, setting, and participantsSeventy consecutive men at a single institution with prostate cancer were prospectively enrolled. Men with prior treatment, metastases, or pelvic radiation were excluded to obtain a final cohort of 55 men. InterventionAll men underwent HIFU focal therapy followed by magnetic resonance (MR)-fusion biopsy 12 mo later. Tissue change was quantified intraoperatively by measuring the backscatter of ultrasound waves during ablation. Outcome measurements and statistical analysisGleason grade group (GG) ≥2 cancer on postablation biopsy was the primary outcome. Secondary outcomes included GG ≥1 cancer, Prostate Imaging Reporting and Data System (PI-RADS) scores ≥3, and evidence of tissue destruction on post-treatment magnetic resonance imaging (MRI). A Student's t - test analysis was performed to evaluate the mean TCM scores and efficacy of ablation measured by histopathology. Multivariate logistic regression was also performed to identify the odds of residual cancer for each unit increase in the TCM score. Results and limitationsA lower mean TCM score within the region of the tumor (0.70 vs 0.97, p = 0.02) was associated with the presence of persistent GG ≥2 cancer after HIFU treatment. Adjusting for initial prostate-specific antigen, PI-RADS score, Gleason GG, positive cores, and age, each incremental increase of TCM was associated with an 89% reduction in the odds (odds ratio: 0.11, confidence interval: 0.01–0.97) of having residual GG ≥2 cancer on postablation biopsy. Men with higher mean TCM scores (0.99 vs 0.72, p = 0.02) at the time of treatment were less likely to have abnormal MRI (PI-RADS ≥3) at 12 mo postoperatively. Cases with high TCM scores also had greater tissue destruction measured on MRI and fewer visible lesions on postablation MRI. ConclusionsTissue change measured using TCM values during focal HIFU of the prostate was associated with histopathology and radiological outcomes 12 mo after the procedure. Patient summaryIn this report, we looked at how well ultrasound changes of the prostate during focal high-intensity focused ultrasound (HIFU) therapy for the treatment of prostate cancer predict patient outcomes. We found that greater tissue change measured by the HIFU device was associated with less residual cancer at 1 yr. This tool should be used to ensure optimal ablation of the cancer and may improve focal therapy outcomes in the future.

Medium-term oncological outcomes of totally laparoscopic colectomy with intracorporeal anastomosis for right-sided and left-sided colon cancer: propensity score matching analysis

BackgroundThis retrospective study aimed to compare long-term oncological outcomes between laparoscopic-assisted colectomy (LAC) with extracorporeal anastomosis (EA) and totally laparoscopic colectomy (TLC) with intracorporeal anastomosis (IA) for colon cancers, including right- and left-sided colon cancers.MethodsPatients with stage I–III colon cancers who underwent elective laparoscopic colectomy between January 2013 and December 2017 were analyzed retrospectively. Patients converted from laparoscopic to open surgery and R1/R2 resection were excluded. Propensity score matching (PSM) analysis (1:1) was performed to overcome patient selection bias.ResultsA total of 388 patients were reviewed. After PSM, 83 patients in the EA group and 83 patients in the IA group were compared. Median follow-up was 56.5 months in the EA group and 55.5 months in the IA group. Estimated 3-year overall survival (OS) did not differ significantly between the EA group (86.6%; 95% confidence interval (CI), 77.4–92.4%) and IA group (84.8%; 95%CI, 75.0–91.1%; P = 0.68). Estimated 3-year disease-free survival (DFS) likewise did not differ significantly between the EA group (76.4%; 95%CI, 65.9–84.4%) and IA group (81.0%; 95%CI, 70.1–88.2%; P = 0.12).ConclusionTLC with IA was comparable to LAC with EA in terms of 3-year OS and DFS. TLC with IA thus appears to offer an oncologically feasible procedure.

Outcomes of salvage radical prostatectomy after initial irreversible electroporation treatment for recurrent prostate cancer.

To evaluate: (i) safety, (ii) feasibility, and medium-term (iii) oncological and (iv) functional outcomes of salvage radical prostatectomy (sRP) for recurrent localised prostate cancer (PCa) following initial focal therapy using irreversible electroporation (IRE). An international, multicentre and retrospective analysis of prospectively collected data of patients that underwent sRP for recurrent localised PCa after initial primary IRE treatment. Data were reported on (i) surgical complications, (ii) feasibility of sRP reported by surgeons, (iii) time interval between IRE and sRP and pathology results, and (iv) urinary continence, erectile function, and quality of life. In four participating centres, a total of 39 patients with a median (interquartile range [IQR]) age 64 (60-67) years were identified. No serious adverse events occurred during or following sRP and surgery was deemed feasible without difficulties. The median (IQR) time to recurrence following IRE was 14.3 (9.1-38.8) months. Pathology results showed localised disease in 21 patients (53.8%) and locally-advanced disease in 18 (46.2%). Positive surgical margins (PSMs) were observed in 10 patients (25.6%), of which six (15.4%) had significant PSMs. A persistent detectable prostate-specific antigen level was found in one case after sRP, caused by metastatic disease. One patient had a biochemical recurrence 6 months after sRP. These two cases, together with a PSM case, required additional therapy after sRP. After a median (IQR) follow-up of 17.7 (11.8-26.4) months, urinary continence and erectile function were preserved in 34 (94.4%) and 18 patients (52.9%), respectively, while quality of life remained stable. Salvage RP is safe and feasible for patients with recurrent localised PCa following initial IRE treatment. The medium-term oncological and functional outcomes are similar to primary RP. Strict patient selection for focal therapy and standardised follow-up is needed as some patients developed high-grade disease.

Robotic versus Laparoscopic Total Mesorectal Excision Surgery in Rectal Cancer: Analysis of Medium-Term Oncological Outcomes.

Background. Robotic systems can overcome some limitations of laparoscopic total mesorectal excision (L-TME), thus improving the quality of the surgery. So far, many studies have reported the technical feasibility and short-term oncological results of robotic total mesorectal excision (R-TME) in treating rectal cancer (RC); however, only a few evaluated the survival and long-term oncological outcomes. The following study compared the medium-term oncological data, 3-year overall survival (OS), and disease-free survival (DFS) of L-TME and R-TME in patients with rectal cancer. Methods. In this retrospective study, records of patients (patients with stage I-III rectal cancer) who underwent surgery (127 cases of L-TME and 148 cases of R-TME) at the Gansu Provincial Hospital between June 2016 and March 2018 were included in the analysis. Kaplan-Meier analysis evaluated the 3-year OS and DFS for all patients treated with curative intent. Results. The conversion rate was significantly higher, and the postoperative hospital stay was significantly longer in the L-TME group than in the R-TME group (all P<.05). Major complications were significantly lower in the robotic group (P<.05). The 3-year DFS rate (for all stages) was 74.8% for L-TME and 85.8% for R-TME (P = .021). For disease stage III, the 3-year DFS and OS were significantly higher in the R-TME group (P<.05). Conclusion. R-TME can achieve better oncological outcomes and is more beneficial for RC patients compared with L-TME, especially for those with stage III rectal cancers. Nevertheless, further randomized controlled trials and a longer follow-up period are needed to confirm these findings.

Isotope-Only Localization for Sentinel Lymph Node Biopsy - Medium-Term Oncological Outcomes

AimsIsotope and blue dye dual localization in sentinel lymph node biopsy (SLNB) gives localization rates of over 98% and is the recommended technique. However blue dye risks a range of adverse reactions. Since 2010, for clinically node negative disease, we have only used blue dye if there is no clear isotope signal at surgery. MethodsElectronic records of patients who underwent isotope-only SLN localization between July 2010 and April 2012 were examined. Data were collected on localization and oncological outcomes. Results426 patients were included. Isotope-only localization rate was 97.4% (415/426). The median follow-up was 63.5 months (IQR: 60.7-70.9). Median age was 57 (IQR: 48-67). Median SLN yield was 2 (range: 1-5). Axillary recurrence rate was 1.4% with median time to recurrence of 39.3 months. In-breast recurrence, distant disease and contralateral breast cancer rates were 2.8%, 7%, and 1.9% respectively and 15 (3.5%) patients died of metastatic breast cancer. ConclusionIsotope-only SLNB has a comparable localization rate to dual isotope/blue dye SLNB and can spare the risk of blue dye adverse reactions. The low axillary recurrence rate, maintained to more than 5 years, confirms that isotope-only SLNB is a feasible and safe alternative to dual blue dye/isotope localization.

EP.TU.4973 year oncological outcomes of robotic-assisted versus laparoscopic rectal cancer resections – a single centre experience

Abstract Background Robotic-assisted minimally invasive surgery (MIS) for rectal cancer is a relatively new technique. Studies to date suggest that short term outcomes including TME quality, margin status, lymph node retrieval and 30-day morbidity and mortality are equivalent in robotic-assisted and laparoscopic MIS for rectal cancer. By contrast, there is a paucity of data on the medium and long-term oncologic safety of robotic-assisted comparative to laparoscopic surgery for rectal cancer. Methods A retrospective review was conducted of all robotic-assisted (n = 31) and laparoscopic (n = 23) rectal cancer cases performed at our institution between January 2016 to December 2018. Inclusion criteria were patients scheduled electively for a laparoscopic or robotic-assisted resection of rectal cancer (anterior resection or abdomino-perineal resection). Patients with distant metastases at presentation, those who proceeded to surgery as an emergency and those with a non-colorectal primary were excluded from analysis. Results A total of 54 (n = 54) cases met the inclusion criteria and were included in the final analysis. The median follow-up was 34 months. Of the 54, 21 patients received neoadjuvant chemoradiotherapy prior to definitive surgery. No significant difference was detected in local recurrence rates (p = 0.5), overall survival (p = 0.7) or disease-free survival (p = 0.8) between the robotic-assisted and laparoscopic cohorts. Conclusion In this series, robotic-assisted rectal cancer resections were associated with equivalent medium term oncological outcomes as laparoscopic procedures. However, given the small numbers in this cohort, outcomes from larger scale datasets will be required to confirm these results.

Medium-term oncological and functional outcomes of hemi-gland brachytherapy using iodine-125 seeds for intermediate-risk unilateral prostate cancer

PURPOSETo examine medium-term outcomes of hemi-gland low-dose-rate brachytherapy as a primary treatment for intermediate-risk prostate cancer. METHODSWe recruited intermediate-risk unilateral prostate cancer patients for a prospective trial of hemi-gland brachytherapy. Twenty-four patients underwent hemi-gland iodine-125 seed implantation with a prescribed dose of 160 Gy. Serum prostate-specific antigen (PSA) was measured regularly and follow-up biopsy was scheduled after 2–3 years of treatment. When clinically needed afterward, for-cause biopsy was performed to confirm pathology. Treatment failure (TF)-free survival, which was defined as freedom from radical or systemic therapy, metastases, and cancer-specific mortality, was assessed, as was biochemical failure (BF)-free survival. Urinary and sexual functions were also evaluated. RESULTSMedian follow-up duration was 61 months. Twenty-two patients (92%) exhibited a declining trend or decreased value of PSA for 12 months or longer after the treatment. Follow-up biopsy in the initial triennium and for-cause biopsy in the subsequent triennium were performed in 16 and four patients, respectively, and cancer was found from the treated lobe in one patient (4% of the cohort) and significant cancer was found from untreated lobes in four patients (17%) in total. Secondary treatments were performed in six patients successfully. Five-year freedom from BF, TF, and metastasis was 71%, 90%, and 100%, respectively. The International Prostate Symptom Score significantly deteriorated at 3 months and reversed itself afterward. The International Index of Erectile Function 5 had no significant decrease. CONCLUSIONSHemi-gland low-dose-rate brachytherapy provides favorable medium-term oncological outcomes with genito-urinary functional preservation for men with intermediate-risk unilateral prostate cancer.

Focal therapy, time to join the multi-disciplinary team discussion?

Organ preserving management is common place in renal cancer, breast cancer and many other solid organ tumours. Current strategies in managing intermediate risk prostate cancer include either whole gland treatment, in the form of radical radiotherapy or radical prostatectomy, or active surveillance. The former is associated with significant post-treatment functional morbidity, whilst the latter associated with the burden of surveillance activity and patient anxiety. Focal therapy would logically fit as a middle ground for suitable patients in whom treatment would be recommended, but where much better functional outcomes may be possible. Ideally this comes without restricting the successful prevention of harm from the cancer. Historically limitations in developing tissue preserving focal therapy strategies in prostate cancer, were due to inaccuracies in tumour characterisation prior to treatment and during follow up. Consequently for example many patients undergoing an active surveillance strategy were being upgraded and upstaged within a short period. Recently high level evidence supporting the use of MRI and targeted biopsies, in particular the PROMIS and PRECISION trials have strengthened clinician confidence in accurate disease characterisation, thus making focal therapy to become a more feasible management option. With improved diagnostic strategies and the publication of reassuring medium term oncological and functional outcomes after focal therapy for intermediate risk prostate cancer, has the time come to require consideration of focal therapy within our multi-disciplinary team (MDT) meetings and with patients? In this review we will consider patient selection and the evidence for the various focal ablation options as well as the surveillance of these patients after treatment. The forthcoming trials to determine comparative effectiveness will be discussed.

Whole and hemi-gland cryoablation for primary localized prostate cancer: Short and medium-term oncological and functional outcomes

IntroductionTo compare oncological, functional and post-operative outcomes of hemi (HC) vs whole gland (WGC) cryoablation as first line treatment of localized prostate cancer. Material and methodSixty-six consecutive patients undertaking whole-gland cryoablation (WGC=40) or hemi-cryoablation (HC=26) in a tertiary referral centre between 2010 and 2018 were included. All patients had a low-intermediate risk prostate cancer according to D’Amico risk classification. Hemi-ablation was proposed in case of biopsy and prostate MRI proven unilateral prostate cancer. Primary endpoint was Cryotherapy Failure for which 3 definitions were considered and compared: 1) biochemical failure (> PSA nadir + ≥2ng/mL), 2) positive prostate re-biopsy with Gleason score≥7, 3) initiation of further prostate cancer treatment. ResultsMedian patients age at treatment was 74 [42–81] vs 76 [71–80] years in WGC vs HC group, respectively (p=0.08). Low and intermediate D’Amico risk group were 15% and 85% vs 23% and 77% (p=0.75), respectively. Median follow- up time was 41[1.5–99.0] vs 27 [0.9–93] months (p=0.03). Four-years cryotherapy failure free survival in WGC vs HC were 69% vs 53% with definition 1 (p=0.24), 82% vs 80% with definition 2 (p=0.95), 83% vs 77% with definition 3 (p=0.73).Early and 1-year urinary continence were 60% and 83% in WGC vs 72% and 83% in HC (p=0.26). De novo impotency after cryotherapy was 75% vs 46% (p=0.33) in WGC vs HC. ConclusionsIn our cohort of highly selected patients with unilateral low/intermediate risk PCa, hemi-cryoablation may provide similar oncological outcomes and less early complications compared to whole-gland cryoablation.

Re: Medium-term Oncologic Outcomes in a Large Cohort of Men Treated with Focal or Hemi-ablation Using High-intensity Focused Ultrasonography for Primary Localized Prostate Cancer

Re: Medium-term Oncologic Outcomes in a Large Cohort of Men Treated with Focal or Hemi-ablation Using High-intensity Focused Ultrasonography for Primary Localized Prostate Cancer

Cryothérapie totale de la prostate sous IRM par voie périnéale : résultats carcinologiques et facteurs prédictifs

To determine the pejorative predictive factors on oncologic outcomes of percutaneous MR-guided whole gland prostate cancer cryoablation (CA). Medical records of patients treated from 2009to 2012, to assess medium-term oncologic outcomes, were reviewed. Prostate biopsies were performed in local recurrence suspicion (biochemical failure, MR follow-up failure). Among 18patients, mean age of 72.6 (61-78), 2 (11%) and 7 (38.9%) biological and reported biopsy-proven local recurrence respectively with our initial technic of CA. Mean follow-up and recurrence were 56.3 (±21.7) and 20.7 (±13.9) months respectively. A previous treatment of prostate cancer (P=0.5), pre-treatment PSA (P=0.2), pre-treatment Gleason/ISUP score (P=0.4), nadir PSA post-CA (P=0.22) were not associated with recurrence. Bilateral positive cores appears as a pejorative predictive factor (P=0.04). However mean pre-treatment positive cores percentage, 25 (±16.5) in responding patients versus 40.7 (±25.2) in case of recurrence, and maximum percentage of cancer extent in each positive core, 10.6 (±9.3) in responding patients versus 18.7 (±16.5) in case of recurrence, seemed associated with local recurrence after prostate CA but our analysis wasn't able to find a difference (P=0.09and P=0.3respectively) due to a lack of power. Bilateral positive cores appears as a pejorative predictive factor. In our experience, important tumor volume seem to be a pejorative predictive factor for oncologic outcomes after PCA whereas treatment, PSA, Gleason/ISUP score, nadir PSA are not. 4.

Ultrahypofractionation Should be a Standard of Care Option for Intermediate-Risk Prostate Cancer

Ultrahypofractionation Should be a Standard of Care Option for Intermediate-Risk Prostate Cancer

SC82 - Medium term oncological outcomes in a large cohort of men treated with either focal- or hemi-ablation with HIFU for primary localized prostate cancer

SC82 - Medium term oncological outcomes in a large cohort of men treated with either focal- or hemi-ablation with HIFU for primary localized prostate cancer