BACKGROUNDThe therapeutic approach of metastatic renal cell carcinoma (RCC) represents a real challenge for clinicians, because of the variable clinical course; the recent availability of numerous ...targeted therapies that have significantly improved overall oncological results, but still with a low percentage of complete responses; and the increasing role of metastasectomy (MSX) as an effective strategy to achieve a durable cure, or at least defer initiation of systemic therapies, in selected patients and in the context of multimodality treatment strategies. CASE SUMMARYWe report here the case of a 40-year-old man who was referred to our unit in November 2004 with lung and mediastinal lymph nodes metastases identified during periodic surveillance 6 years after a radical nephrectomy for RCC; he underwent MSX of multiple lung nodules and mediastinal lymphadenectomy, with subsequent systemic therapy with Fluorouracil, Interferon-alpha and Interleukin 2. The subsequent clinical course was characterized by multiple sequential abdominal and thoracic recurrences, successfully treated with multiple systemic treatments, repeated local treatments, including two pancreatic resections, conservative resection and ablation of multiple bilobar liver metastases, resection and stereotactic body radiotherapy of multiple lung metastases. He is alive without evidence of recurrence 20 years after initial nephrectomy and sequential treatment of recurrences in multiple sites, including resection of more than 38 metastases, and 5 years after his last MSX. CONCLUSIONThis case highlights that effective multimodality therapeutic strategies, including multiple systemic treatments and iterative aggressive surgical resection, can be safely performed with long-term survival in selected patients with multiple metachronous sequential metastases from RCC.
The neoplasms of the penis are extremely rare and have an incidence of 1400 new cases for year in the United States. Higher is the percentage of incidence in Africa and Asia (10-20%) and in some ...areas of Brasil where the cancer of the penis constitutes 17% of all the male tumors. In Israel this neoplasm is rare, less than 0.1/100000 menfor year, because in Jewish population men are circumcised prematurely. Recently it has been placed attention to the possible aetiologic role of human papillomavirus (HPV-16 and HPV-18) in penis carcinoma. In fact, in the tumoral cells, DNA of this virus has been found with a percentage that varies from the 30 to 82%. Traditional surgical approach is total or partial penis resection basing on the extension of the disease. This procedure is associated to remarkable psycosessuals problems that greatly affect the quality of life. We bring back a case with organ sparing conservative treatment.
Renal Cell Carcinoma Imaging Pavlica, Pietro; Derchi, Lorenzo; Martorana, Giuseppe ...
European urology supplements : official journal of the European Association of Urology,
06/2006, Letnik:
5, Številka:
8
Journal Article, Conference Proceeding
Review the role of imaging in detecting, characterising, and staging renal cell carcinoma (RCC). The imaging features are described and the different diagnostic criteria are analysed based on the ...methodology used.
The techniques of urography, sonography, computed tomography (CT), and magnetic resonance imaging (MRI) are described and new advances reported synthetically.
Currently, urography and angiography are rarely used in urologic practice in developed countries because the cross-imaging techniques have a higher sensitivity and specificity in detecting, characterising, and staging renal tumours. High attenuation values at CT, signal intensity not typical of water or adipose tissue at MRI, and the presence of septations, wall thickening, and nodularity are the main criteria used to define the nature of an expansive renal lesion. The use of ultrasound with and without contrast agents has great promise even if multidetector CT is widely used for the evaluation of the kidneys.
Imaging has a major role in detecting and staging of tumoural renal masses. The technical improvements have been associated with a decrease in size of the RCC at diagnosis and in down-staging of the lesions. In many cases the differentiation between a benign and malignant neoplasm is possible
To compare surgical, functional and early survival outcomes for robot-assisted radical cystectomy (RARC) with intracorporeal orthotopic neobladder (ONB) reconstruction in patients age = 75 y to those ...in patients age < 75 y using Propensity Score Matching.
We collected data from 15 patients age = 75 y from among 60 consecutive RARC with ONB reconstruction performed at our institution from January 2015 to July 2018. All procedures were performed by a single surgeon after modular training under the supervision of a skilled surgeon. Demographic, surgical, functional and survival data were prospectively collected and compared to the corresponding data from 15 patients from the same series age < 75 y, matched according to the ASA score, body mass index, clinical stage and associated carcinoma in situ using Propensity Score Matching.
There were no significant differences between the two groups with regard to preoperative parameters, such as ASA score, BMI and preoperative stage. The same homogeneity was found for intraoperative parameters, such as operation time, number of nodes retrieved and ONB time. The only statistically significant difference noted was in the percentage of nerve-sparing procedures, which was higher in the younger patient group (p < 0.001). The percentages of early and late postoperative complications were higher in the older patients, but the differences were not statistically significant. Moreover, there were no differences among the two populations in terms of functional outcomes (daytime and nighttime continence, potency), or in either cancer-specific or overall mortality.
RARC with totally intracorporeal ONB diversion can be offered to older patients with an expectation of good surgical, functional and early survival outcomes, although further studies with a larger sample size will be needed to confirm these results.
To compare the perioperative and short-term outcomes of robotic pyelolithotomy (RP) and laparoscopic pyelolithotomy (LP) for the treatment of renal stones.
We retrospectively evaluated 39 patients ...who underwent robotic or laparoscopic pyelolithotomy from January 2015 to December 2018.
The preoperative characteristics of the two groups were comparable. The mean operative time was 173 ± 51 and 182 ± 62 min in the RP and LP groups, respectively (p=0.6). Blood loss and length of hospital stay with the robotic approach were lower than those with the laparoscopic approach (210 ± 180 ml vs. 639 ± 412 ml, p<0.001, and 3.8 ± 3 days vs. 7.3 ± 2.8 days, p=0.001). A complete stone-free status was achieved in 17 (85%) patients in the RP group and 8 (42%) in the LP group (p=0.01). Post-operative complications with the two approaches were also similar.
In some selected cases, laparoscopic and robotic pyelolithotomy are alternative procedures for large, multiple and complex kidney stones. The robotic approach was associated with less intraoperative blood loss and fewer days of hospitalization compared to the laparoscopic method, and also gives a better stone-free rate.
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