Robotic-assisted radical prostatectomy (RAP) is the dominant minimally invasive surgical treatment for patients with localized prostate cancer. The introduction of robotic assistance has the ...potential to improve surgical outcomes and reduce the steep learning curve associated with conventional laparoscopic radical prostatectomy. The purpose of this video is to demonstrate the early retrograde release of the neurovascular bundle without open the endopelvic fascia during RAP.
A 51-year old male, presenting histological diagnosis of prostate adenocarcinoma, Gleason 6 (3+3), in 4 cores of 12, with an initial PSA=3.41ng/dl and the digital rectal examination demonstrating a prostate with hardened nodule in the right lobe of the prostate base (clinical stage T2a). Surgical treatment with the robot-assisted technique was offered as initial therapeutic option and the critical technical point was the early retrograde release of the neurovascular bundle with endopelvic fascia preservation, during radical prostatectomy.
The operative time was of 89 minutes, blood loss was 100ml. No drain was left in the peritoneal cavity. The patient was discharged within 24 hours. There were no intraoperative or immediate postoperative complications. The pathological evaluation revealed prostate adenocarcinoma, Gleason 6, with free surgical margins and seminal vesicles free of neoplastic involvement (pathologic stage T2a). At 3-month-follow-up, the patient lies with undetectable PSA, continent and potent.
This is a feasible technique combining the benefits of retrograde release of the neurovascular bundle, the preservation of the pubo-prostatic collar and the preservation of the antero-lateral cavernous nerves.
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e16056
Background: Partial nephrectomy (PN) is the standard of care in the management of cT1a tumors, while radical nephrectomy (RN) is indicated in more advanced tumors. Recent studies ...provided evidence that PN could be performed in patients with tumors greater that 7 cm with complication rates and oncological outcomes comparable with those undergoing RN. This study compares the recurrence-free survival (RFS), overall (OS) and cancer-specific survival (CSS) of PN and RN in patients with non-metastatic pathological T3a renal cell carcinoma (RCC) with perirenal fat invasion only. Methods: We reviewed 1202 patients undergoing RN (n = 653) and PN (n = 549), at a oncological referral center, from January 2003 to June 2016. Of all patients, we identified 25 RN and 41 PN pT3a tumors with exclusively perirenal fat invasion. None had nodal or distant metastasis at pretreatment clinical staging. Patients characteristics were compared with Mann-Whitney U test and Student t-test for categorical and numeric variables with normal distribution, respectively. Both groups were compared for RFS, OS and CSS with a Kaplan-Meier survival analysis. Results: All patients included had pT3a stage with isolated perirenal fat invasion. Groups undergoing RN and PN were not significantly different regarding Charlson Comorbidity Index (Median 3 for RN vs 4 for PN, p = 0.24) or Age (Mean 65.3 for RN vs 62.0 for PN, p = 0.99). Patients undergoing RN had bigger tumors (7.9 cm vs 4.6, p < 0.001) and higher Fuhrman grade (p = 0.01). Median follow-up was 36 months for RN and 34 months for PN. At the end of follow-up, recurrence was seen in 3 patients undergoing RN (12%) and 2 undergoing PN (5%), p = 0.36. Mortality was similar across groups (16% for RN vs 15% for PN, p = 0.99) as well as Cancer-specific mortality (4% for RN vs. 5% for PN, p = 0.99). At the end of follow-up, RFS was 80% (20/25) for RN and 82% (34/41) for PN. Conclusions: In our data, renal cell carcinoma with T3 stage due to perirenal fat invasion exclusively had similar outcomes when treated with Radical or Partial Nephrectomy. OS as well as RFS were comparable for both surgical modalities, suggesting that, although RN is currently the gold standard for this staging, PN may provide similar oncologic results.
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e16079
Background: The prognostic significance and optimal management of positive surgical margins following partial nephrectomy remain controversial. The association between positive ...margin and risk of disease recurrence in patients with clinically localized renal neoplasm undergoing partial nephrectomy was evaluated. Methods: We analyzed the records of 429 patients cases of non-metastatic renal cell carcinoma who underwent partial nephrectomy (PN) at our institution, from 2001 to 2016. Recurrence free-survival was evaluated using Kaplan–Meier method and the log rank test and Cox models adjusting for tumor size, grade, histology, pathological stage, focality and laterality. The relationship between positive margin and risk of relapse was evaluated independently for pathological high risk (Fuhrman grades III-IV) and low risk (Fuhrman grades I-II) groups Results: A positive surgical margin was found in 55 (12.8%) patients. Recurrence developed in 26 (6%) patients during a median follow up of 39 months. A positive margin was associated with an increased risk of relapse on multivariable analysis (HR 3.19, CI 95% 1.21 – 7.61 p=0.02) (Table). In a stratified analysis based on pathological features, a positive surgical margin was significantly associated with a higher risk of recurrence in cases of high risk (HR 13.8, CI 95% 4.19–45.9, p = 0.0005). Conclusions: Positive surgical margins after partial nephrectomy increase the risk of disease recurrence, primarily in patients with high-risk pathological features. Table: see text
To evaluate the relation between serum total testosterone (TT) and prostate cancer (PCa) grade and the effect of race and demographic characteristics on such association.
We analyzed 695 patients ...undergoing radical prostatectomy (RP), of whom 423 had serum TT collected. Patients were classified as having hypogonadism or eugonadism based on two thresholds of testosterone: threshold 1 (300 ng/dL) and threshold 2 (250 ng/dL). We evaluated the relation between TT levels and a Gleason score (GS) ≥ 7 in RP specimens. Outcomes were evaluated using univariate and multivariate analyses, accounting for race and other demographic predictors.
Out of 423 patients, 37.8% had hypogonadism based on the threshold 1 and 23.9% based on the threshold 2. Patients with hypogonadism, in both thresholds, had a higher chance of GS ≥ 7 (OR 1.79, p=0.02 and OR 2.08, p=0.012, respectively). In the multivariate analysis, adjusted for age, TT, body mass index (BMI) and race, low TT (p=0.023) and age (p=0.002) were found to be independent risk factors for GS ≥ 7. Among Black individuals, low serum TT was a stronger predictor of high-grade disease compared to White men (p=0.02).
Hypogonadism is independently associated to higher GS in localized PCa. The effect of this association is significantly more pronounced among Black men and could partly explain aggressive characteristics of PCa found in this race.
A new phenylpropanoid derivative, named euploic acid (1), was isolated from Euploca procumbens (Mill.) Diane & Hilger, Boraginaceae, along with lithospermic acid B (2), lithospermic acid (3), ...9’’-methyl lithospermate (4), and luteolin-7-O-glucoside (5). Compound structures were determined by mass spectrometry (MS), nuclear magnetic resonance (NMR) analysis and comparison with published data. Absolute configuration of 1 was established via electronic circular dichroism (ECD). Anti-inflammatory potential of euploic acid (1) was assessed by measuring its inhibition of cytokine and nitric oxide production in stimulated J774 macrophages. Compound 1 significantly reduced pro-inflammatory mediator production and release by stimulated macrophages at non-cytotoxic concentrations, comparable to the efficacy of dexamethasone. Our findings demonstrate the potential of euploic acid (1) as an effective anti-inflammatory agent. This study contributes to the structural elucidation of a new phenylpropanoid derivative and highlights its promising anti-inflammatory activity in the treatment of inflammatory disorders.
Water resources sustainability is an increasing concern, requiring accurate estimates of the hydrological processes involved. This study evaluates the impacts of climate change (CC) and land use (LU) ...in a river basin in the Brazilian semi-arid. Using the Soil & Water Assessment Tool (SWAT), calibration/ validation was carried out based on limited measurements for discharge and using complementary remote sensing information for evapotranspiration (ET), as well as experimental data for soil moisture (SM). The evapotranspiration data used for calibration were obtained from the MOD16A2 product, at sub-basin scale. Principal component analysis was used to evaluate the interaction between variables. To assess the impacts of CC e and LU two scenarios were investigated: S1 – LU map without insertion of Permanent Preservation Areas (PPA), and S2 – with insertion of PPA. The Regional Climate Models (RCM) Eta-MIROC5 and Eta-HADGEM-ES for the Representative Concentration Pathway (RCP) 4.5 and 8.5 scenarios were adopted. The SWAT model adequately represented evapotranspiration, with Nash-Sutcliffe coefficient (NS) of 0.67 for calibration, and 0.74 for validation. For wet periods, the SM simulated values were similar to the experimental measurements with a coefficient of determination (R²) of 0.68. Complementary information for evapotranspiration and soil moisture across sub-basins successfully allowed consistent spatially distributed hydrological variables to be simulated. The model performance for validation using ET data was higher (NS = 0.77) compared to previous streamflow-only calibration strategies for flow (NS = 0.42) and soil moisture (NS = 0.46). Under the CC scenarios, natural vegetation restoration would compensate reductions in water availability.
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