Organ-sparing Surgery Research Articles

Small renal mass: which criteria are decisive for a tumor board?

Small renal masses (SRM) are aheterogeneous group of tumors with varying metastatic potential. The increasing use and improvement in the quality of abdominal imaging have led to an increasingly earlier diagnosis of incidental SRM, which are asymptomatic and confined to the organ. Despite these advances in imaging and the growing use of renal tumor biopsies, preoperative diagnosis of malignancy remains difficult. The treatment of SRM has shifted away from radical nephrectomy and now primarily includes organ-sparing surgery or active surveillance. The optimal strategy for treating SRM is continuously evolving as studies from prospective data registries can identify factors that influence both short- and long-term patient outcomes. Recent research on biomarkers, imaging techniques, and machine learning offer promising approaches to adeeper understanding of tumor biology and treatment options for this patient population.

A pilot study to evaluate the combination of surgery and brachytherapy for local tumor control in young children with perianal rhabdomyosarcoma

BackgroundPerianal rhabdomyosarcoma ((P)RMS) are rare and have a poor prognosis. Data in young children are limited and local therapy is not well defined. Combined brachytherapy and surgery is routinely being used for RMS at other sites in children as it provides good oncologic outcomes and allows for organ-sparing surgery. The objective of this study was to evaluate this combination treatment for local tumor control and organ-sparing surgery in young children with (P)RMS. MethodsA retrospective review of the medical records of all children who underwent surgery and brachytherapy for (P)RMS at our institution since 2009 was conducted. ResultsSurgery for (P)RMS was performed in 6 patients at a median age of 19 months (range 8–50). Embryonal RMS was diagnosed in 4 patients and alveolar RMS in 2 patients, of which 1 patient had FOXO1 fusion-positive RMS. All patients underwent postoperative high-dose rate (HDR) brachytherapy. Organ-preserving surgery was achieved in 5 of 6 patients (83 %). In 1 patient, the entire sphincter was infiltrated, making organ-preserving resection impossible. 5 of 6 patients (83 %) exhibited an event-free and overall survival at a median follow-up of 26 months (range 8–107). One patient died due to locoregional recurrence. Complications were urethral leakage in 1 patient followed by urethral stenosis and delayed wound healing and vaginal stenosis in another patient. No patient reported fecal incontinence. ConclusionsCombined treatment with surgery and HDR brachytherapy is feasible in very young children with (P)RMS and leads to a favorable oncologic outcome. Preliminary data show a good functional preservation.

Functional outcomes of organ sparing surgery for penile cancer confined to glans and premalignant lesions.

The first-line treatment of penile cancer confined to the glans (Tis-T2) is based on organ-sparing approaches. Our aim is to report functional outcomes of total glans resurfacing (TGR), wide local excision (WLE) and glansectomy. A retrospective analysis was conducted from January 2013 to October 2022. Ninety-nine patients were enrolled (22 TGR, 29 WLE, and 48 glansectomy). Sexual and urinary outcomes were explored using ad hoc and validated questionnaires (IIEF-15 and IPSS). The mean follow-up was 25.28 ± 24.87 months [95% CI: 20.38; 30.18]. 44 patients (12 TGR, 10 WLE, and 22 glansectomy) were assessed for functional outcomes. Overall, 86.36% of patients were satisfied with the surgery. The mean IIEF-15 score pre-operation was 54.91 ± 21.38 [95% CI: 48.41-61.41], and at 12 months post-operation, it was 44.39 ± 23.01 [95% CI: 37.39-51.39], with the change being statistically significant (mean difference: -10.52, (-19.15), p < 0.001). During the 0-12-month interval, IIEF-15 scores decreased across all techniques. Glansectomy and WLE showed significant decreases (Glansectomy: -12.955, -24.14%, [95% CI: -21.52, -4.38], p = 0.002; WLE: -14.1, -22.92%, [95% CI: -26.8, -1.39], p = 0.025 respectively), whereas TGR experienced a non-significant decrease (-3.083, -5.97%, CI: [-14.68, 8.51], p = 1.0). Concerning urinary function, only 18.18% of overall patients reported a negative impact of surgery. At 12-months, patients returned almost to pre-intervention IPSS values. Organ-sparing surgery guarantees a decent preservation of both erectile and voiding functions. TGR seems to provide better sexual outcomes when compared to other organ sparing approaches.

Abstract IA015: Optimizing cystectomy outcomes in MIBC: What's new in 2024?

Abstract Muscle-invasive bladder cancer often requires radical cystectomy, which is a major and complex surgery carrying significant morbidities. Optimizing the outcomes of radical cystectomy involves a multifaceted approach. There are three main aspects that we must focus on, namely the peri-operative, functional and oncological outcomes. Firstly, perioperative outcomes can be enhanced by leveraging robotic technology for the procedure, coupled with intracorporeal urinary diversion techniques. Recent evidence has shown benefits in terms of reducing blood loss, shortening hospital stay and improving quality of life. Secondly, to optimize functional outcomes, organ sparing surgery techniques can be considered when possible. Preserving organ function can improve the quality of life after surgery, especially in terms of urinary and sexual functioning. Thirdly, optimizing oncological outcomes can be achieved through the integration of neoadjuvant immunotherapy into treatment protocols. This innovative approach can potentially improve the long-term survival outcomes following radical cystectomy. By addressing these three key aspects, a more comprehensive and effective strategy can be developed to optimize the results of radical cystectomy for patients with muscle-invasive bladder cancer. Citation Format: Jeremy Teoh. Optimizing cystectomy outcomes in MIBC: What's new in 2024? [abstract]. In: Proceedings of the AACR Special Conference on Bladder Cancer: Transforming the Field; 2024 May 17-20; Charlotte, NC. Philadelphia (PA): AACR; Clin Cancer Res 2024;30(10_Suppl):Abstract nr IA015.

Neoadjuvant immunotherapy in microsatellite instability-high (MSI-H) duodenal adenocarcinoma leads to pathological complete response and paves the way for new strategies

Duodenal adenocarcinoma is a rare digestive cancer, often diagnosed at a late stage and harbours a poor prognosis. The arrival of immunotherapy has changed the prognosis of many neoplasia, including digestive adenocarcinomas with MSI-H status. Hereby, we describe three cases of MSI-H locally advanced duodenal adenocarcinoma who received neoadjuvant treatment with a PD1 inhibitor, pembrolizumab. A partial metabolic and endoscopic response was observed in all patients after 2 cycles. Duodenopancreatectomy was performed at the end of treatment (4–6 cycles), and anatomopathological analysis demonstrated pathological complete response in all patients. Our case series paves the way for prospectively exploring neoadjuvant immunotherapy in duodenal MSI-H adenocarcinoma and raises the question of organ sparing surgery in case of complete clinical response as observed in gastric and colo-rectal adenocarcinomas.

Vulvar Carcinoma: Standard of Care and Perspectives.

Treatment of vulvar carcinoma (VC) is challenging. The objectives of this review were to describe for clinicians the epidemiologic and clinical aspects of VC, the standard of care in terms of primary local treatment and systemic therapies, and the recent innovations and perspectives emerging from translational research in immuno-oncology. We conducted a comprehensive review outlying the clinical aspects and biologic background of vulvar cancer, highlighting modern treatment strategies on the basis of a personalized approach. Epidemiologic data showed a recent rise in incidence of VC, attributed to human papillomavirus. Surgery is the mainstay of primary treatment, but multimodal approaches are frequently required in the presence of adverse prognosis histopathologic factors. Chemoradiation is indicated when organ-sparing surgery is not feasible. However, inability to achieve high locoregional control rates in advanced cases and the morbidity associated with local treatments are still key issues. Recent clinical data showed the benefit of individualized strategies combining organ-sparing surgical strategies, less invasive lymph node staging procedures, and refinement in radiotherapy modalities. Among the most important research area, there is a sound rationale for testing modern systemic approaches such as immune checkpoint inhibitors in selected patients with recurrent and/or metastatic tumors. Although no specific data exist for VC, the role of supportive care and post-treatment rehabilitation strategies is also crucial. There are still insufficient studies dedicated to patients with VC. Public health programs for prevention, screening, and early diagnosis are required, and clinical research should be strengthened to provide high-quality clinical evidence and improve patients' oncologic and functional outcomes.

Bilateral pheochromocytoma in patients with von Hippel–Lindau syndrome: clinical and molecular genetic features

Bilateral adrenal pheochromocytoma (PCС) is extremely rare in children, with major predisposing factors being multiple endocrine neoplasia type 2 and von Hippel–Lindau syndrome. In case of bilateral PCC with underlying von Hippel–Lindau syndrome, organ-preserving surgery is preferred in view of the low malignant potential of such neoplasms. We aimed to study clinical and molecular genetic features of patients with bilateral adrenal PCCs treated at the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Ministry of Healthcare of the Russian Federation. The study was approved by the Independent Ethics Committee and the Scientific Council of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Ministry of Healthcare of the Russian Federation. The study included 20 patients with paraganglioma (PGL)/PCC (PPGL) who had received treatment (n = 17) or outpatient care (n = 3) at the Center over the period from 2012 to 2023. Bilateral adrenal PCC was diagnosed in 4 (20%) patients. In all these cases, the diagnosis was confirmed by histology. Molecular genetic testing was carried out at the Laboratory of Molecular Biology at the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Ministry of Healthcare of the Russian Federation in order to search for germline pathogenic variants in PCC/PGL susceptibility genes. The median age of the four patients with bilateral adrenal PCC was 9.5 years (range 4.5–14.6 years). All the patients were male. In one patient, synchronous bilateral PCC/PGL was observed. In 100% of the cases, arterial hypertension was diagnosed at the onset of the primary disease and was treated with alpha-blockers as part of preparation for surgery. According to the results of a 24-hour urine biochemistry test, all the patients had at least a 4-fold increase above the upper limit of normal for normetanephrine levels. Molecular genetic testing using the multiplex ligation-dependent probe amplification method revealed a pathogenic germline variant in exon 3 of the VHL gene in all the children (4/4). Hereditary PPGL was proven in 2/4 (50%) patients. In all the cases, R0/R1 resection was achieved. Organ-sparing surgery on one/two adrenal glands was performed in 3/4 cases. One out of four (25%) patients developed a local relapse 18.4 months after diagnosis. The overall survival rate in this group was 100%, with a median follow-up time of 8.1 months (range 0.8–50.2 months). Bilateral adrenal PCC is a very rare childhood tumor. A medical genetic consultation is necessary to identify tumor predisposition syndromes. A multidisciplinary team discussion of a surgical strategy is recommended, with organ-sparing surgery on one or two adrenal glands being the treatment of choice that should be carried out at centers specializing in pediatric surgical oncology. Here, we report a rare clinical case of bilateral retroperitoneal PCC/PGL in a patient with von Hippel-Lindau syndrome. The patient's parents gave consent to the use of their child's data, including photographs, for research purposes and in publications.

Laparoscopic Double Discoid Colorectal Resection for the Treatment of Two Distinct Deep Endometriotic Nodules

To show the surgical steps used to perform a laparoscopic double discoid colorectal resection for the excision of 2 distinct deep endometriotic nodules (DENs). Stepwise demonstration of the technique with narrated video footage. To date there is agreement that discoid resection should be the first choice procedure in patients eligible for surgical treatment with rectal, unifocal DENs measuring ≤ 3 cm [1-3]. For surgical management of lesions of the sigmoid colon, current international guidelines suggest to perform segmental resections [3]. Data on surgical treatment of multiple colorectal DENs separated by a great distance from each other are very limited, mostly owing to the rarity of such a diagnosis. In particular, there is paucity of data concerning the efficacy and safety of a double discoid resection for surgical management of distinct DENs found in the sigmoid colon and rectum [4]. In a context of multiple colorectal DENs, the decision-making process with respect to a double discoid excision must take into consideration both the distance between the 2 nodules and the nodules' distance from anal verge. When technically feasible, such organ-sparing surgery allows preserving the healthy bowel interposed between the endometriotic lesions, seeming to offer advantages in terms of quicker return of bowel function and better rectal functional outcomes than segmental colorectal resection. The patient was a 36-year-old woman experiencing drug treatment failure and presenting with refractory constipation, dyschezia, dysmenorrhea, dyspareunia, cyclical abdominal bloating, and chronic pelvic pain. Preoperative ultrasonography revealed the presence of an endometriotic nodule of 19×6×16 mm deeply infiltrating the tunica muscularis of the sigmoid colon. A second DEN was found at the level of the rectum, the latter measuring 19×5×12 mm and having a distance of 9 cm from the anal verge. Both the intestinal lesions resulted to have a circumferential extent of 30%. The distance between the 2 nodules was 15 cm. A 3-dimensional laparoscopy was performed. Sigmoid colon and rectal mobilization were performed according to our standardized technique [5-7]. A 31-mm circular stapler was used to excise first the nodule of the sigmoid colon. The stapler, in its closed position, was gently introduced into the rectum via the anus and then progressively advanced inside the large bowel up to the level of the sigmoid nodule. After correct positioning, the stapler was completely opened and the nodule was imbricate between the anvil and staple housing of the stapler. Then, the stapler was closed and fired. The procedure was repeated using a second 31 mm circular stapler to resect the rectal endometriotic nodule. The overall operative time was 90 minutes. The estimated blood loss was 5 mL. Neither intra- nor postoperative complications occurred. The patient was discharged 3 days after surgery. The sigmoid colon and rectal endometriotic nodules measured, respectively, 20×6×15 mm and 20×5×12 mm on fresh unfixed specimens. Both nodules were found to have endometriosis-free surgical margins on definitive pathology. The operative technique displayed in this video may contribute to the standardization of a procedure, which could be included among the options available in the surgical armamentarium, to be used in selected cases of multiple colorectal DENs each having 3 cm or less in diameter. Surgeon experience and an adequate preoperative evaluation are of utmost importance to plan the operative strategy and have the best chance of surgical success.

Impact of the Standardization of Penile Cancer Care on the Quality of Care, Outcomes, and Academic-driven Centralization in a Single eUROGEN Referral Center

BackgroundPenile cancer (PeCa) represents a diagnostic and therapeutic challenge given the low patient volume, which may result in inadequate physician expertise and poor guideline adherence. Since 2015, we have developed a specific care pathway for PeCa in our tertiary referral center. ObjectiveTo evaluate the impact of a dedicated PeCa care pathway on patient management, the adequacy of pathological reporting, and oncological outcomes. Design, setting, and participantsWe retrospectively queried our institutional registry (S-66482) to identify patients who were surgically treated for PeCa between January 1989 and April 2022. The patient numbers were evaluated within a broader national context. Outcome measurements and statistical analysisWe compared patient, surgery, tumor, and pathological data before and after 2015. Kaplan-Meier analysis was used to compare local and regional recurrence rates and cancer-specific survival (CSS). Results and limitationsOverall, 313 patients were included, of whom 204 (65.1%) were surgically treated after 2015. The median number of patients treated yearly was significantly higher after 2015 (26 vs 5; p < 0.01). Patients treated after 2015 more frequently had no palpable lymph nodes at diagnosis, despite similar primary tumor stage. After adoption of the PeCa care pathway, organ-sparing surgery (OSS) was more commonly performed (79.9% vs 57.8%; p < 0.01) despite local staging being similar and without observing a significant increase in positive margins. Surgical staging in patients with European Association of Urology intermediate- or high-risk tumors was conducted more frequently after 2015 (90% vs 41%; p < 0.01). Pathology reporting was standardized, and there was more frequent reporting of p16 staining status (81.4% vs 8.3%; p < 0.01), lymphovascular invasion (93.8% vs 44.3%; p < 0.01), and perineural invasion (92.4% vs 44.3%; p < 0.01) following implementation. ConclusionsImplementation of a standardized care pathway for PeCa resulted in higher rates of OSS and pathological nodal staging and more complete pathology reports. Considering that these changes were associated with an increase in the number of patients treated, academic-driven centralization may play a role in optimizing the management of these patients. Patient summaryWe evaluated the impact of a care pathway for patients with penile cancer on patient management, the completeness of pathology reporting, and cancer control. We found that implementation of this pathway was associated with an increase in the number of patients treated, higher rates of organ-sparing surgery and lymph node staging, and more complete pathology reports. Centralization of care may play a role in optimizing the management of penile cancer.

Organ-Sparing Surgery for Testicular Germ Cell Tumors: A Current Perspective.

Background and Objectives: We aimed to evaluate the oncological and functional outcomes of organ-sparing surgery for testicular germ cell tumors, a procedure that seeks to strike a balance between effective cancer control and organ preservation, in the treatment of testicular tumors. We aimed to discuss the surgical technique and complications, and determine the appropriate candidate selection for this approach. Material and Methods: A comprehensive literature search was conducted to identify relevant studies on organ-sparing surgery for testicular tumors. Various databases, including PubMed, Embase, and Cochrane Library, were used. Studies reporting on surgical techniques, complications, and oncologic and functional outcomes were included for analysis. Results: Current evidence suggests that organ-sparing surgery for testicular germ cell tumors can be considered a safe and efficacious alternative to radical orchiectomy. The procedure is associated with adequate oncological control, as indicated by low recurrence rates and low complication rates. Endocrine testicular function can be preserved in around 80-90% of patients and paternity can be achieved in approximately half of the patients. Candidate selection for this surgery is typically based on the following criteria: pre-surgery normal levels of testosterone and luteinizing hormone, synchronous or metachronous bilateral tumors, tumor in a solitary testis, and tumor size less than 50% of the testis. Conclusions: Organ-sparing surgery for testicular germ cell tumors offers a promising approach that balances oncological control and preservation of testicular function. Further research, including large-scale prospective studies and long-term follow-ups, is warranted to validate the effectiveness and durability of organ-sparing surgery and to identify optimal patient selection criteria.

Adnexal Torsion in Adolescents – a Retrospective Analysis from a Tertiary Centre in Latvia

Objective - To review the data of cases of adnexal torsion in the paediatric population in a national level centre in Latvia and examine the pitfalls of diagnostic and therapeutic strategies.Methods - A retrospective review of medical records was performed on 61 cases of suspected and/or confirmed adnexal torsion in a national level paediatric centre.Results - In 85.5% of cases the initial diagnosis was made correctly. The age of the patient was a significant contributor to a shorter time until surgery (P=0.016). Abdominal pain was the most common symptom (90.6%), followed by nausea (58.5%) and vomiting (52.8%). Only 62.3% of the torsion patients had an elevated WBC and 69.4% had no elevated body temperature. The shorter the duration of symptoms, the more likely it was that the organ salvage procedure was performed (P=0.021). The sensitivity of ultrasound for the correct diagnosis was 71.4%. In almost a third of the torsion cases, no pelvic lesion was detected on ultrasound (26.5%). When ultrasound suspected torsion, the time before operation was significantly shorter (P&lt;0.001), the presence of blood flow in the ovary extended the time until surgery (P=0.026). Organ-sparing surgery was performed in 73.6% of the cases.Conclusion - Medical professionals should not exclude the diagnosis of adnexal torsion in the absence of fever or leucocytosis, as well as in the case of normal adnexa on ultrasound. A delay in surgery increases the risk of irreversible ischemic damage leading to organ loss.

Analysis of options for prescribing hormone replacement therapy after thyroid organ-sparing surgery

Background. Performing thyroid organ-sparing surgery primarily aims to preserve the quality of life. Organ-sparing surgery should be understood as hemithyroidectomy with mandatory removal of the isthmus and pyramidal lobe of the thyroid (if present). The choice of one or another concept of prescribing hormone replacement therapy remains debatable. The purpose of the study is to determine the proportion of patients who do not need replacement therapy with levothyroxine after organ-sparing surgery on the thyroid gland, among those who were prescribed replacement therapy immediately and one month after discharge from the hospital, as well as to analyze the factors causing hypothyroidism in people with hemithyroidectomy. Materials and methods. The first group included 82 patients with hemithyroidectomy who were prescribed replacement therapy immediately after discharge from the hospital. The second group included 61 patients with hemithyroidectomy. The administration of replacement therapy was postponed for one month. A month after the operation, clinical examinations and monitoring of thyroid-stimulating hormone and free thyroxine indicators were performed. Results. After one month of observation, 72 (87.8%) of 82 patients in the first group continued to take levothyroxine, and 8 (13.1%) of 61 persons in the second group began to take it. In the first group, there was a moderate direct correlation between thyroid-stimulating hormone level before surgery and levothyroxine dose one month after (Spearman’s correlation coefficient 0.304, p=0.009). It was found that the chances of continuing taking levothyroxine after one month in the first group were 47 times higher than the chances of prescribing levothyroxine after one month in the second group. The proportion of patients in the first group who continued to take levothyroxine after one month was significantly higher than the proportion of patients in the second group who started taking levothyroxine after one month (87.8±3.6% vs. 13.1±3.5%, p&lt;0.0001, Fisher’s exact test). Conclusions. Among patients who were prescribed hormone replacement therapy immediately after hemithyroidectomy, 12.2% did not need to continue taking levothyroxine after one month. Among persons in whom the administration of hormone replacement therapy was postponed for one month after hemithyroidectomy, 86.9% of patients did not require the use of levothyroxine in the future. The volume of the thyroid remnant ≤ 3.67 cm3 can be considered a predictor for hypothyroidism occurrence in the future, with a high risk of prescribing hormone replacement therapy. The study of such a factor as the ratio of the remnant thyroid volume to the body weight did not provide statistically reliable data for its use as a predictor of hypothyroidism occurrence in the postoperative period.

Treatment tactics for patients with combined kidney tumor and urolithiasis (clinical cases)

Annotation. Global medical literature shows an ever-increasing number of patients suffering from urolithiasis and malignant kidney tumors. The number of patients suffering from both conditions also seems to be on the rise. Correlation and interdependence, as well as the preferable course of treatment for these diseases, remain uncertain. The present study aims to map out treatment strategies for patients presenting with both urolithiasis and kidney tumor. In 2013- 2021 21 patients with urolithiasis and kidney tumor were examined and treated in the SI “Acad. O.F. Vozianov Institute of Urology NAMS of Ukraine”. In 61.9% of cases a tumor and calculi were located unilaterally, in 14.3% contralaterally, and in other 14.3% tumor was comorbid with bilateral urolithiasis. 4.75% of patients had a tumor combined with a stone in the upper third of the ureter on the same side, and 4.75% – in the lower third of the ureter on the opposite side. Depending on the localization of a tumor and a stone, the stage of the oncological process, the presence of metastases, clinical manifestations, etc, different treatment tactics have been employed. Simultaneous removal of a kidney tumor and a stone in case of their ipsilateral location was performed in 52.4% of patients. We prioritized organ-sparing surgery in all cases. 9.52% of patients underwent PNLT before the tumor removal. In 9.52% of patients ureterolith removal was followed by kidney tumor removal. 71.4% of patients underwent successful laparoscopic resection of a tumorous kidney, but in 28.6% of patients, attempts to save the organ failed. So, types of combinations of urolithiasis and kidney tumor can be different, hence, it is necessary to apply individual treatment tactics in each case. If the functional state of a tumorous kidney and technical capacity allow it, organ-sparing surgery is highly advisable.

Functional outcomes and health-related quality of life following penile cancer surgery: a comprehensive review.

Organ-sparing surgery (OSS) in penile cancer management aspires to maintain organ form and function and preserve health-related quality of life (HRQoL), yet there is a lack of integrated evidence exploring these outcomes. The aim sought to review HRQoL, functional, aesthetic, and psychological outcomes following OSS or radical penectomy for penile cancer. A systematic review of MEDLINE and Cochrane databases included studies reporting on function (sexual, urinary or sensory), genital appearance or HRQoL/psychological well-being following surgical treatment of primary penile cancer. English-language reports (2000-2022), incorporating patient-reported or objective clinical outcome measures, were eligible. Studies of nonsurgical treatment strategies and those in the context of metastatic disease were excluded. Data were compiled and analyzed. Twenty-six studies were included. Sexual function was the most studied outcome (754 pooled respondents; 19 studies), most frequently with the original 15-item and abridged 5-item International Index of Erectile Function. Preservation of erectile function following OSS is generally described, with some reduction in overall sexual satisfaction cited. Heterogeneous assessment of voiding function with little preoperative evaluation render interstudy comparison difficult. Most patients appear able to void from a standing position following OSS, with spraying the most common symptom. Maintenance of some sensory function is described with both split-thickness skin grafting and urethral glanduloplasty following radical glansectomy. Limited studies suggest reasonable patient satisfaction with genital cosmesis post-OSS. A negative impact on HRQoL is described in most studies following penile cancer surgery, variably correlated with aggressiveness of penile surgery and addition of lymphadenectomy. Anxiety, depression, and reduced self-esteem have been reported in penile cancer survivors. Relationship well-being varies, with some survivors reporting this to be unchanged. OSS can preserve elements of sexual, urinary, and sensory function, supporting advantages over radical penectomy for eligible patients. However, a comprehensive understanding remains limited due to small, heterogeneous patient cohorts, challenges in obtaining premorbid data, and variability in outcome measures. Standardization of patient-reported outcomes following OSS is desirable.

Organ-sparing treatment for breast cancer

This article reviews literature on organ-sparing and oncoplastic surgeries for breast cancer. Initially, we performed organ-sparing surgeries in patients with stage I—IIA breast cancer and then compared outcomes with those in patients after radical mastectomy. Since there were no differences in both overall and relapse-free survival between the groups, we started to perform organ-sparing surgeries in women with locally advanced breast cancer after neoadjuvant therapy who achieved complete or partial response. Oncoplastic resections were used to achieve good aesthetic results and also for patients in whom classical organ-sparing resection would inevitably result in a poor cosmetic outcome due to the tumor location. In recent years, the technique of extreme oncoplastic breast resection has emerged as a promising option that extended the scope of indications to organ-sparing treatment. In particular, it allows breast conservation for patients with multicentric, multifocal tumors, and tumors &gt;50 mm. All organ-sparing and oncoplastic operations first of all improve the quality of life of breast cancer patients.

Retroperitoneoscopic resection with preoperative selective embolization and indocyanine green fluorescence visualization of vessels in kidney cancer

Background. Currently, kidney cancer is considered one of the most common oncological pathologies, accounting for 2–3 % of all cancers. In 2018, the total number of primary renal cell carcinoma patients in Ukraine was 4,805 cases, with 1,878 patients dying from this disease. Surgical treatment is the only way for 68 % of patients with localized kidney cancer. The main question remains unanswered — an effective surgical treatment of patients with localized renal cell carcinoma. Our aim was to study the kidney function parameters in localized kidney cancer after retroperitoneoscopic resection with preoperative selective embolization compared to standard kidney resection using thermal ischemia. Materials and methods. Data of 65 patients with localized kidney cancer who underwent nephron-sparing surgery were analyzed. They were divided into two groups. The first one included 40 people with localized kidney cancer who underwent standard organ-sparing surgery with duration of thermal ischemia of less than 20 minutes. The second group consisted of 25 patients with localized kidney cancer who underwent computed tomography with renal vessels reconstruction in the preoperative stage. Branch of the renal artery that feeds the area of the kidney with the tumor was identified. As a next step, selective embolization was performed. Retroperitoneoscopic resection was carried out the next day with fluorescence imaging in the infrared light using indocyanine green. Results. Analysis of the data shows that renal function after surgery for local cancer in case of retroperitoneoscopic resection with preoperative selective embolization of renal vessels is more functionally suitable compared to kidney resection using thermal ischemia. Conclusions. Our data suggest that superselective X-ray vascular embolization and intraoperative indocyanine green fluorescence in the surgical treatment of localized kidney cancer has significant advantages over the standard method of surgical treatment.

MP33-09 GLANSECTOMY AND NEOGLANS RECONSTRUCTION USING SPLIT-THICKNESS SKIN GRAFT / ACELLULAR DERMAL MATRIX FOR PENILE CANCER

You have accessJournal of UrologyCME1 Apr 2023MP33-09 GLANSECTOMY AND NEOGLANS RECONSTRUCTION USING SPLIT-THICKNESS SKIN GRAFT / ACELLULAR DERMAL MATRIX FOR PENILE CANCER Haijun Yao, Dachao Zheng, Jianshu Ni, Xiang Wan, and Zhong Wang Haijun YaoHaijun Yao More articles by this author , Dachao ZhengDachao Zheng More articles by this author , Jianshu NiJianshu Ni More articles by this author , Xiang WanXiang Wan More articles by this author , and Zhong WangZhong Wang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003266.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Penectomy as the traditional surgical treatment of penile cancer has substantial adverse functional and psychological impact. Organ-sparing surgery is recommended in selected penile cancer patients.Glansectomy and Neoglans reconstruction aims to provide curative resection while maximizing functional outcomes and minimizing psychological harm.To show the efficacy and safety of glansectomy and neoglans reconstruction using split-thickness skin graft (STSG) and Acellular Dermal Matrix (ADM). METHODS: Using our prospectively derived database, we identified 25 patients with penile squamous-cell carcinoma involving the glans, who were treated using glansectomy and neoglans reconstruction between March 2015 and December 2021. All the patients underwent total glansectomy and reconstruction of a new glans, of whom 18 (82%) with STSG and 7 with ADM. Deep spongiosal biopsies are taken to exclude invasion as a standard practice. The glans is excised and a neoglans is created using STSG/ADM. These 25 patients represent the subject of our study (mean age 57 years, range 45 to 71 years). RESULTS: 92% of patients (23/25) reported to be fully satisfied with the postoperative aesthetic appearance. The apex of corpora cavernosa was transected in 5 cases due to local invasion. Positive surgical margins were no detected in all the cases. 2 patients (8%) experienced local recurrence during the follow-up period. 4 patients had early partial loss of the graft (STSG 2 vs ADM 2). Two late complications occurred with urethral meatus stricture. CONCLUSIONS: Glansectomy and Neoglans reconstruction using STSG/ADM comprise a safe procedure in terms of oncologic control and complications for patients with penile cancer confined to the glans. Further studies are required to assess functional and sexual outcomes in these patients.The overall satisfaction rate and recovery of the sexual function are acceptable, and it can be considered an ideal procedure to treat superficial penile cancer. Source of Funding: The Project of Biobank (No. YBKB202119) from Shanghai 9th People's Hospital,Shanghai Jiao Tong University,School of Medicine © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e453 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Haijun Yao More articles by this author Dachao Zheng More articles by this author Jianshu Ni More articles by this author Xiang Wan More articles by this author Zhong Wang More articles by this author Expand All Advertisement PDF downloadLoading ...

Short- and long-term results of organ-sparing surgery in patients with severe diffuse adenomyosis at perimenopausal transition

Aim. To study the short- and long-term results of organ-sparing surgery in patients with severe diffuse adenomyosis who are in the perimenopausal age.Materials and Methods. The study included 18 patients with severe diffuse adenomyosis who underwent fertility-sparing excision of diffuse adenomyosis by means of Osada procedure. Efficiency of surgical treatment and subsequent drug therapy was evaluated at 12 and 24 months of follow-up by pelvic ultrasound examination. The frequency of adenomyosis symptoms and quality of life were assessed using the standard SF-36 questionnaire.Results. Recovery of the menstrual cycle, freedom from pain and anemia, and improved quality of life were documented in all cases (18/18), whereas onset of menopause occurred in half of the cases (9/18). In particular, all scales of the Physical Component Summary from SF-36 questionnaire were significantly improved at both follow-up time points.Conclusion. Organ-sparing excision of diffuse adenomyosis using Osada procedure is the option of choice and might represent an alternative to hysterectomy in women with perimenopausal age, in addition to those of earlier reproductive age.

Optimization of postoperative surveillance protocols in upper tract urothelial cancer: A retrospective cohort study.

Upper tract urothelial carcinoma (UTUC) is an aggressive disease that is managed by radical or organ-sparing surgery. High recurrence rates require early detection and strict follow-up (FU) protocols. Recommendations are assigned to a low level of evidence. Our aim was to identify time-to-tumor recurrence, analyze the temporal relation to recommended FU regimens, and provide a critical proposal for further surveillance. This retrospective study included 54 patients receiving radical nephroureterectomy (RNU) in high-risk UTUC and 14 patients assigned to kidney-sparing surgery (KSS) with low-risk disease. FU surveillance protocols consisted of close intervals irrespective of the received type of surgery. In total, 68 patients were included with a median FU of 23 months. Mean overall survival (OS) was significantly shorter in RNU compared to KSS (P = .027). Recurrence in the bladder and/or upper urinary tract (UUT) was 57.1% in KSS and 38.9% after RNU (P = .241). Mean recurrence-free survival (RFS) was significantly shorter in RNU patients compared to KSS (22.4 vs. 47.9 months, P = .013), and 76.2% of the recurrences in the RNU group occurred in the first postoperative year. UUT recurrence was diagnosed after a median of 3.0 (RNU) and 25.0 (KSS) months. There was a frequent onset of metastases in the RNU group, with 85.7% in the first year compared to the KSS group with 50%. Multivariable regression analysis showed that the tumor stage was the parameter independently related to OS (P = .002), RFS (P = .008), and metastasis-free survival (MFS, P = .002). In conclusion, surveillance of UTUC should be adapted to real-time occurrence patterns. Strict imaging protocols are recommended in the first two years irrespective of the method of surgery. As recurrence is equally distributed over the years after KSS, cystoscopy should be offered regularly for five years and diagnostic URS for three years. After RNU, cystoscopies should be decreased to yearly intervals after year three. Contralateral UUT should also be examined after RNU.

Quality of life in breast cancer patients over the age of 65 years after organ-sparing treatment with or without radiation therapy

Objective. To study the impact of radiation therapy (RT) after organ-sparing surgery (OSS) for breast cancer (BC) on quality of life (QoL) in patients over the age of 65 years. Subjects and methods. The investigation enrolled 133 patients with Stage IA BC who underwent OSS. The patients were divided into 2 groups: 1) patients who had received RT after surgical treatment; 2) those who had not. All the patients included in the investigation received adjuvant hormone therapy for ≥5 years. The mean follow-up period was 61.77±20.10 months. QoL was comparatively assessed using the EORTC QLQ-C30 Version 3 and EORTC QLQ-BR23 questionnaires. Results. The scores on functional and symptom scales and those on the EORTC QLQ-C30 V.3 Global health status/QoL were statistically comparable in the examined groups (p &gt; 0.05). Statistically significant differences between the groups were obtained in assessing the EORTC QLQ-BR23 Body image (BRBI). Arm symptoms (BRAS), and Breast symptoms (BRBS) (p0.05). Conclusion. After CCA with and without RT, the patients older than 65 years showed no significant differences in the assessment of QoL using the Global health status/QoL symptom, functional, and BRFU scales. QoL assessment using BRBI, BRBS, and BRAS demonstrated lower scores in the RT group. Thus, it may be concluded that RT does not worsen the overall QoL in patients, whereas it exerts local side effects in the area of irradiated tissues.