Mid-term Oncological Outcomes Research Articles

Robot-assisted radical prostatectomy: advances since 2005

To provide an update of recent studies relevant to robot-assisted radical prostatectomy, highlighting technical modifications and associated functional outcomes, mid-term oncologic results and patient perception and satisfaction. Several recent studies have investigated methods of further reducing the morbidities associated with prostatectomy, namely erectile dysfunction and incontinence. These studies provide important anatomic insights into additional mechanisms responsible for potency and incontinence and measures for preserving both. Mid-term oncologic outcomes have also been reported; further substantiating the role of robotics in the treatment of clinically localized prostate cancer. The technique of robotic prostatectomy has evolved over the last decade with significant efforts in improving functional outcomes following surgery. However, aggressive-marketing campaigns and lack of regulation of hospital websites may be contributing to unrealistic expectations in patients who choose to undergo robotic prostatectomy, resulting in dissatisfaction for some patients. National interests in this topic will likely result in the mandate for more stringent studies to assess the comparative effectiveness of robot-assisted prostatectomy with other competing therapies for clinically localized prostate cancer.

Video-endoscopic Inguinal Lymphadenectomy

Penile carcinoma is a rare malignant disease with a significantly higher incidence in some areas of underdeveloped countries. Inguinal nodal involvement is found in 20–40% of cases at diagnosis and nodal metastasis is an important predictive factor for survival. Although recent data demonstrated a survival benefit with immediate resection of clinically occult lymph-node metastases, surgical morbidity is still high. Videoendoscopic inguinal lymphadenectomy (VEIL) was described in the clinical arena six years ago to duplicate the open template, reducing morbidity without compromising oncological control. All technical variations described for open surgery were safe and feasible using the endoscopic approach. In terms of reproducibility, preliminary results of a worldwide survey identified that 11 centres were already performing VEIL. Reduced morbidity and good midterm oncological results are important arguments for growing acceptance of this new minimally invasive option to manage inguinal lymph nodes in high-risk penile cancer patients.

Laparoscopic versus open radical cystectomy for the management of bladder cancer: Mid‐term oncological outcome

To compare the mid-term oncological outcome of laparoscopic radical cystectomy (LRC) with those of open radical cystectomy (ORC). From June 2003 to February 2008, 36 LRCs were carried out at our institute for the treatment of bladder cancer. Clinical and oncological data were retrospectively analyzed. A match-pair comparison with an historical series of 34 patients who were submitted to ORC between 1996 and 2003 was carried out. Median follow-up of the LRC group was 21 months (3-56 months). Pathological stage or grade was similar in the two groups. There was no significant difference between the LRC and ORC groups in terms of 3-year overall (64.2% vs 72.6%, respectively; P = 0.682), cancer-specific (73.0% vs 75.3%, respectively; P = 0.951), and recurrence-free survival (70.5% vs 72.5%, respectively; P = 0.715) rates. In a subgroup analysis according to stage, there was also no significant difference in the 3-year disease-specific survival after LRC or ORC for organ-confined (pT1 and pT2; 85.7% vs 83.9%, respectively; P = 0.256) or extravesical disease (pT3 and pT4; 73.3% vs 63.8%, respectively; P = 0.825). These findings suggest that LRC provides mid-term oncological outcomes similar to those of ORC in the management of bladder cancer.

Technical advances in robot-assisted laparoscopic radical prostatectomy.

Since it was introduced in 1999, the da Vinci Surgical System has become an integral tool in urologic surgery, specifically in the management of localized prostate cancer. The original technique of robot-assisted laparoscopic prostatectomy (RALP) was developed and standardized in 2000 at the Institut Mutualiste Monsouris. Since that time, the technique of RALP has undergone various modifications. The driving force behind the evolution of the RALP technique in the past decade has been based on efforts to improve upon the three main objectives of surgery, namely the 'trifecta' of cancer cure and the preservation of potency and of urinary continence. In this review, we aim to provide an update on the midterm oncologic outcomes of RALP and focus specifically on two technical modifications that have been introduced in an effort to optimize the outcomes of potency and earlier return of urinary continence.

Tratamiento actual de las masas renales pequeñas

Incidental diagnosis of renal carcinoma (RC) is increasingly common due to widespread use of radiodiagnostic techniques for other conditions. In developed countries, incidental tumor account for more than 40% of detected tumors, and 80% of solid kidney tumors less than 4 cm in size are malignant. Standard treatment for these tumors is partial nephrectomy, and their relapse rate is 1%-2% The higher increase in diagnosis of this disease has occurred in patients aged 70 to 90 years, a group where associated comorbidities are very common. In the past two decades, in parallel to development of radiographic techniques, two ablation procedures achieving tumor necrosis through cold, cryotherapy, and through heat, radiofrequency, have become established. These procedures achieve 95% short- and long-term remissions in tumors less than 4 cm in size. In addition, since these procedures may be performed percutaneously, both complications and hospital stay have decreased. As early as in 1995, Bosniak, based on observation of the growth and behavior of small RCs for longer than 8 years, advocated a watchful waiting or active surveillance attitude. This article reports cryotherapy, our radiofrequency series, and a literature review. ConclusionsIn the event of elderly patients, concomitant diseases advising against surgery, multiple renal tumors, a solitary kidney, or patients who reject surgery, ablation procedures may be safe and effective when performed by expert hands, achieving mid-term oncological results similar to partial nephrectomy. Active surveillance has also been shown to be safe in the mid-term in adequately informed patients. To improve indications, new diagnostic procedures that help us differentiate the potentially more aggressive tumors will be required. Larger series and longer follow-ups are neede to confirm current results.

Video-assisted axillary surgery for cancer: Non-randomized comparison with conventional techniques

Endoscopic techniques have been introduced in most of surgical disciplines including surgery for breast cancer. However, there is shortage of evidence-based guidelines and oncological outcome data. We present a controlled trial of endoscopic axillary surgery for breast cancer with mid-term oncologic results. Fifty cases of axilloscopy for sentinel node biopsy, axillary sampling or full axillary dissection were included. Sentinel node biopsy was accomplished with the blue dye technique. Full axillary dissection was performed with a three-port approach with gas insufflation without liposuction. Endoscopic axillary dissection significantly lowered duration of drainage and operative blood loss. Lymph node harvest with endoscopic approach was significantly lower than with open procedure. One case developed axillary recurrence. Endoscopic sentinel node biopsy yielded identification rate of 80%. Current data do not justify the oncological safety of resectional endoscopic procedures. Endoscopically assisted axillary cancer surgery is technically feasible. The technique is valuable to maximize utility of blue dye method for sentinel lymphadenectomy in areas with no access to radio-guided surgery.

Laparoscopic resection for rectal cancer: a prospective analysis of thirty-month follow-up outcomes in 312 patients

This study aimed to prospectively evaluate operative safety and mid-term oncologic outcomes of laparoscopic rectal cancer resection performed by a single surgeon. Three hundreds twelve patients (male, 181) were enrolled in this analysis. 257 patients (82.4%) had tumors located below 12 cm from the anal verge. Distribution of TNM stages was 0:I:II:III:IV = 4.2%:17.9%:32.4%:37.2%:8.3%. 225 patients (71.1%) had T3/T4 lesions. Pre- and post-operative radiation was given in 6 and 20 patients, respectively. Sphincter-preserving operation was performed in 85.9%. Mean operating time was 212 minutes. Conversion rate was 2.6%. Overall morbidity rate was 21.1%. Anastomotic leakage occurred in 6.4%. Operative mortality rate was 0.3%. Mean number of harvested nodes was 23. Mean distal tumor-free margin was 2.8 cm. The circumferential resection margin was positive in 13 patients (4.2%). With a mean follow-up of 30 months in the stage I-III patients, the local recurrence rate was 2.9%. Systemic recurrence occurred in 11.7%. No port-site recurrence was observed. Laparoscopic resection of rectal cancer provided safe operative parameters and adequate mid-term oncologic outcomes. When considering a high volume of advanced and low-lying cancers but rather narrow indication to radiotherapy, the 2.9% local recurrence rate seems promising data. Long-term follow-up is mandatory to draw conclusion.

Minimally Invasive Esophagectomy for Cancer: Prospective Evaluation of Laparoscopic Gastric Mobilization

Esophagectomy carries high morbidity, mainly respiratory. Minimally invasive surgery has been demonstrated to improve postoperative outcome in digestive surgery, without impairment of oncological results. A prospective study was conducted to evaluate feasibility, postoperative outcome, and mid-term oncological results of minimally invasive esophagectomy (MIE) in cancer. From July 2001 to August 2005, 25 patients underwent esophagectomy with laparoscopic gastric mobilization (LGM) for epidermoid carcinoma (n=15) or adenocarcinoma (n=10). Tumors were located on the cardia (n=6), on the lower third (n=14), or on the median third (n=5) of the esophagus. Following LGM, transthoracic esophagectomy was performed. Complete LGM was achieved in all patients but 1. Mean operative time for LGM was 191+/-49 minutes. Fifteen patients (60%) developed complications, mainly respiratory. Anastomotic leakage occurred in 2 patients, with a favorable outcome. Pylorospasm (n=1) was the only intra-abdominal complication. Median hospital stay was 18 days. Two patients died (8%). Twenty-three patients underwent R0 resection. A mean of 12+/-4 lymph nodes (range 4-19 nodes) were analyzed. With a mean follow-up of 14 months (1-46 months), actuarial survival at 1 and 2 years was, respectively, 73% and 56%. Esophagectomy with LGM is feasible with few specific complications. However, no decrease in morbidity and hospital stay could be observed. Mid-term oncological results seem comparable to those of conventional surgery. Further studies are required to evaluate the extent of lymphadenectomy and the oncologic safety of MIE.