1
|
De Backer P, Vangeneugden J, Berquin C, Vermijs S, Dekuyper P, Mottrie A, Debbaut C, Quackels T, Van Praet C, Decaestecker K. Robot-assisted Partial Nephrectomy Using Intra-arterial Renal Hypothermia for Highly Complex Endophytic or Hilar Tumors: Case Series and Description of Surgical Technique. EUR UROL SUPPL 2023; 58:19-27. [PMID: 38028235 PMCID: PMC10660005 DOI: 10.1016/j.euros.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Background In partial nephrectomy for highly complex tumors with expected long ischemia time, renal hypothermia can be used to minimize ischemic parenchymal damage. Objective To describe our case series, surgical technique, and early outcomes for robot-assisted partial nephrectomy (RAPN) using intra-arterial cold perfusion through arteriotomy. Design setting and participants A retrospective analysis was conducted of ten patients with renal tumors (PADUA score 9-13) undergoing RAPN between March 2020 and March 2023 with intra-arterial cooling because of expected arterial clamping times longer than 25 min. Surgical procedure Multiport transperitoneal RAPN with full renal mobilization and arterial, venous, and ureteral clamping was performed. After arteriotomy and venotomy, 4°C heparinized saline is administered intravascular through a Fogarty catheter to maintain renal hypothermia while performing RAPN. Measurements Demographic data, renal function, console and ischemia times, surgical margin status, hospital stay, estimated blood loss, and complications were analyzed. Results and limitations The median warm and cold ischemia times were 4 min (interquartile range [IQR] 3-7 min) and 60 min (IQR 33-75 min), respectively. The median rewarming ischemia time was 10.5 min (IQR 6.5-23.75 min). The median pre- and postoperative estimated glomerular filtration rate values at least 1 mo after surgery were 90 ml/min (IQR 78.35-90 ml/min) and 86.9 ml/min (IQR 62.08-90 ml/min), respectively. Limitations include small cohort size and short median follow-up (13 [IQR 9.1-32.4] mo). Conclusions We demonstrate the feasibility and first case series for RAPN using intra-arterial renal hypothermia through arteriotomy. This approach broadens the scope for minimal invasive nephron-sparing surgery in highly complex renal masses. Patient summary We demonstrate a minimally invasive surgical technique that reduces kidney infarction during complex kidney tumor removal where surrounding healthy kidney tissue is spared. The technique entails arterial cold fluid irrigation, which temporarily decreases renal metabolism and allows more kidneys to be salvaged.
Collapse
Affiliation(s)
- Pieter De Backer
- Department of Urology, ERN eUROGEN Accredited Centre, Ghent University Hospital, Ghent, Belgium
- IBiTech-Biommeda, Department of Electronics and Information Systems, Faculty of Engineering and Architecture, Ghent University, Ghent, Belgium
- ORSI Academy, Melle, Belgium
| | - Joris Vangeneugden
- Department of Urology, ERN eUROGEN Accredited Centre, Ghent University Hospital, Ghent, Belgium
| | - Camille Berquin
- Department of Urology, ERN eUROGEN Accredited Centre, Ghent University Hospital, Ghent, Belgium
| | - Saar Vermijs
- IBiTech-Biommeda, Department of Electronics and Information Systems, Faculty of Engineering and Architecture, Ghent University, Ghent, Belgium
| | - Peter Dekuyper
- Department of Urology, AZ Maria Middelares Hospital, Ghent, Belgium
| | - Alexandre Mottrie
- ORSI Academy, Melle, Belgium
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
| | - Charlotte Debbaut
- IBiTech-Biommeda, Department of Electronics and Information Systems, Faculty of Engineering and Architecture, Ghent University, Ghent, Belgium
| | | | - Charles Van Praet
- Department of Urology, ERN eUROGEN Accredited Centre, Ghent University Hospital, Ghent, Belgium
| | - Karel Decaestecker
- Department of Urology, ERN eUROGEN Accredited Centre, Ghent University Hospital, Ghent, Belgium
- Department of Urology, AZ Maria Middelares Hospital, Ghent, Belgium
| |
Collapse
|
2
|
Courboin E, Mathieu R, Panetta V, Mjaess G, Diamand R, Verhoest G, Roumiguié M, Bajeot AS, Soria F, Lonati C, Simeone C, Simone G, Anceschi U, Umari P, Sridhar A, Kelly J, Mertens LS, Sanchez-Salas R, Colomer A, Cerruto MA, Antonelli A, Krajewski W, Quackels T, Peltier A, Montorsi F, Briganti A, Teoh JYC, Pradere B, Moschini M, Roumeguère T, Albisinni S. Comparing Robotic-Assisted to Open Radical Cystectomy in the Management of Non-Muscle-Invasive Bladder Cancer: A Propensity Score Matched-Pair Analysis. Cancers (Basel) 2023; 15:4732. [PMID: 37835425 PMCID: PMC10571883 DOI: 10.3390/cancers15194732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/22/2023] [Accepted: 09/03/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND For non-muscle-invasive bladder cancer (NMIBC) requiring radical surgery, limited data are available comparing robotic-assisted radical cystectomy with intracorporeal urinary diversion (iRARC) to open radical cystectomy (ORC). The objective of this study was to compare the two surgical techniques. METHODS A multicentric cohort of 593 patients with NMIBC undergoing iRARC or ORC between 2015 and 2020 was prospectively gathered. Perioperative and pathologic outcomes were compared. RESULTS A total of 143 patients operated on via iRARC were matched to 143 ORC patients. Operative time was longer in the iRARC group (p = 0.034). Blood loss was higher in the ORC group (p < 0.001), with a consequent increased post-operative transfusion rate in the ORC group (p = 0.003). Length of stay was longer in the ORC group (p = 0.007). Post-operative complications did not differ significantly (all p > 0.05). DFS at 60 months was 55.9% in ORC and 75.2% in iRARC with a statistically significant difference (p = 0.033) found in the univariate analysis. CONCLUSION We found that iRARC for patients with NMIBC is safe, associated with a lower blood loss, a lower transfusion rate and a shorter hospital stay compared to ORC. Complication rates were similar. No significant differences in survival analyses emerged across the two techniques.
Collapse
Affiliation(s)
- Etienne Courboin
- Department of Urology, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, 1070 Brussels, Belgium; (G.M.); (T.Q.); (T.R.); (S.A.)
- Department of Urology, CHU Rennes, 35000 Rennes, France; (R.M.); (G.V.)
| | - Romain Mathieu
- Department of Urology, CHU Rennes, 35000 Rennes, France; (R.M.); (G.V.)
| | - Valentina Panetta
- L’altrastatistica S.R.L., Consultancy & Training, Biostatistics Office, 00100 Rome, Italy;
| | - Georges Mjaess
- Department of Urology, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, 1070 Brussels, Belgium; (G.M.); (T.Q.); (T.R.); (S.A.)
| | - Romain Diamand
- Department of Urology, Institut Jules Bordet, Université Libre de Bruxelles, 1070 Brussels, Belgium; (R.D.); (A.P.)
| | - Gregory Verhoest
- Department of Urology, CHU Rennes, 35000 Rennes, France; (R.M.); (G.V.)
| | - Mathieu Roumiguié
- Department of Urology, Andrology and Renal Transplantation, CHU Rangueil, Paul-Sabatier University, 31000 Toulouse, France; (M.R.); (A.S.B.)
| | - Anne Sophie Bajeot
- Department of Urology, Andrology and Renal Transplantation, CHU Rangueil, Paul-Sabatier University, 31000 Toulouse, France; (M.R.); (A.S.B.)
| | - Francesco Soria
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, 10024 Turin, Italy;
| | - Chiara Lonati
- Department of Urology, Spedali Civili di Brescia, 25123 Brescia, Italy; (C.L.); (C.S.)
| | - Claudio Simeone
- Department of Urology, Spedali Civili di Brescia, 25123 Brescia, Italy; (C.L.); (C.S.)
| | - Giuseppe Simone
- Department of Urology, Regina Elena National Cancer Institute, 00100 Rome, Italy; (G.S.); (U.A.)
| | - Umberto Anceschi
- Department of Urology, Regina Elena National Cancer Institute, 00100 Rome, Italy; (G.S.); (U.A.)
| | - Paolo Umari
- Departement of Urology, Ospedale Maggiore della Caritá di Novara, Universitá del Piemonte Orientale, 28100 Novarra, Italy;
| | - Ashwin Sridhar
- Division of Surgery and Interventional Sciences, University College London, London WC1E 6BT, UK; (A.S.); (J.K.)
| | - John Kelly
- Division of Surgery and Interventional Sciences, University College London, London WC1E 6BT, UK; (A.S.); (J.K.)
| | - Laura S. Mertens
- Department of Urology, Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands;
| | - Rafael Sanchez-Salas
- Department of Urology, Institut Mutualiste Montsouris, 70123 Paris, France; (R.S.-S.); (A.C.)
| | - Anna Colomer
- Department of Urology, Institut Mutualiste Montsouris, 70123 Paris, France; (R.S.-S.); (A.C.)
| | - Maria Angela Cerruto
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, 37100 Verona, Italy; (M.A.C.); (A.A.)
| | - Alessandro Antonelli
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, 37100 Verona, Italy; (M.A.C.); (A.A.)
| | - Wojciech Krajewski
- Department of Minimally Invasive and Robotic Urology, Wrocław Medical University, 50-556 Wroclaw, Poland;
| | - Thierry Quackels
- Department of Urology, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, 1070 Brussels, Belgium; (G.M.); (T.Q.); (T.R.); (S.A.)
| | - Alexandre Peltier
- Department of Urology, Institut Jules Bordet, Université Libre de Bruxelles, 1070 Brussels, Belgium; (R.D.); (A.P.)
| | - Francesco Montorsi
- Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, 20132 Milan, Italy; (F.M.); (A.B.); (M.M.)
| | - Alberto Briganti
- Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, 20132 Milan, Italy; (F.M.); (A.B.); (M.M.)
| | - Jeremy Y. C. Teoh
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China;
| | - Benjamin Pradere
- Department of Urology, University of Vienna, 1010 Vienna, Austria;
- Department of Urology, Hopital La Croix du Sud, 31000 Toulouse, France
| | - Marco Moschini
- Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, 20132 Milan, Italy; (F.M.); (A.B.); (M.M.)
| | - Thierry Roumeguère
- Department of Urology, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, 1070 Brussels, Belgium; (G.M.); (T.Q.); (T.R.); (S.A.)
- Department of Urology, Institut Jules Bordet, Université Libre de Bruxelles, 1070 Brussels, Belgium; (R.D.); (A.P.)
| | - Simone Albisinni
- Department of Urology, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, 1070 Brussels, Belgium; (G.M.); (T.Q.); (T.R.); (S.A.)
- Urology Unit, Department of Surgical Sciences, Tor Vergata University Hospital, University of Rome Tor Vergata, 00100 Rome, Italy
| |
Collapse
|
3
|
Mjaess G, Diamand R, Aoun F, Assenmacher G, Assenmacher C, Verhoest G, Holz S, Naudin M, Ploussard G, Mari A, Tay A, Issa R, Roumiguié M, Bajeot AS, Umari P, Sridhar A, Kelly J, Hendricksen K, Einerhand S, Mertens LS, Sanchez-Salas R, Gallardo AC, Quackels T, Peltier A, Pradere B, Moschini M, Roumeguère T, Albisinni S. Cost-analysis of robot-assisted radical cystectomy in Europe: A cross-country comparison. Eur J Surg Oncol 2023; 49:1511-1518. [PMID: 35970622 DOI: 10.1016/j.ejso.2022.07.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/22/2022] [Accepted: 07/31/2022] [Indexed: 12/18/2022]
Abstract
BACKGROUND Robotic-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) is surging worldwide. Aim of the study was to perform a multicentric cost-analysis of RARC by comparing the gross cost of the intervention across hospitals in four different European countries. METHODS Patients who underwent RARC + ICUD were recruited from eleven European centers in four European countries (Belgium, France, Netherlands, and UK) between 2015 and 2020. Costs were divided into six parts: cost for hospital stay, cost for ICU stay, cost for surgical theater occupation, cost for transfusion, cost for robotic instruments, and cost for stapling instruments. These costs were individually assessed for each patient. RESULTS A total of 490 patients were included. Median operative time was 300(270-360) minutes and median hospital length-of-stay was 11(8-15) days. The average total cost of RARC was 14.794€ (95%CI 14.300-15.200€). A significant difference was found for the total cost, as well as the various subcosts abovementioned, between the four included countries. Different sets and types of robotic instruments were used by each center, leading to a difference in cost of robotic instrumentation. Nearly 84% of costs of RARC were due to hospital stay (42%), ICU stay (3%) and operative time (39%), while 16% of costs were due to robotic (8%) and stapling (8%) instruments. CONCLUSION Costs and subcosts of RARC + ICUD vary significantly across European countries and are mainly dependent of hospital length-of-stay and operative time rather than robotic instrumentation. Decreasing length-of-stay and reducing operative time could help to decrease the cost of RARC and make it more widely accessible.
Collapse
Affiliation(s)
- Georges Mjaess
- Department of Urology, Hôpital Erasme, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium.
| | - Romain Diamand
- Department of Urology, Institut Jules Bordet, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Fouad Aoun
- Department of Urology, Hotel Dieu de France, Beirut, Lebanon
| | | | | | | | - Serge Holz
- Department of Urology, CHU Ambroise Paré, Mons, Belgium
| | - Michel Naudin
- Department of Urology, CHU Ambroise Paré, Mons, Belgium
| | - Guillaume Ploussard
- Department of Urology, La Croix du Sud Hospital, Toulouse, France; Institut Universitaire du Cancer Toulouse - Oncopole, Toulouse, France
| | - Andrea Mari
- Department of Experimental and Clinical Medicine, Unit of Oncologic Minimally-Invasive Urology and Andrology, University of Florence, Careggi University Hospital, Florence, Italy
| | - Andrea Tay
- Department of Urology, Saint Georges Hospital, London, UK
| | - Rami Issa
- Department of Urology, Saint Georges Hospital, London, UK
| | - Mathieu Roumiguié
- Department of Urology, Andrology and Renal Transplantation, CHU Rangueil, Paul-Sabatier University, Toulouse Cedex, France
| | - Anne Sophie Bajeot
- Department of Urology, Andrology and Renal Transplantation, CHU Rangueil, Paul-Sabatier University, Toulouse Cedex, France
| | - Paolo Umari
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Ashwin Sridhar
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - John Kelly
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Kees Hendricksen
- Department of Urology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Sarah Einerhand
- Department of Urology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Laura S Mertens
- Department of Urology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - Anna Colomer Gallardo
- Department of Urology, Institut Mutualiste Montsouris, Paris, France; Department of Urology, Hospital Universitari Germans Trias i Pujol, Badolona, Spain
| | - Thierry Quackels
- Department of Urology, Hôpital Erasme, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium; Department of Urology, Institut Jules Bordet, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Alexandre Peltier
- Department of Urology, Hôpital Erasme, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium; Department of Urology, Institut Jules Bordet, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, France
| | - Marco Moschini
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Thierry Roumeguère
- Department of Urology, Hôpital Erasme, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium; Department of Urology, Institut Jules Bordet, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Simone Albisinni
- Department of Urology, Hôpital Erasme, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium; Department of Urology, Institut Jules Bordet, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium; Urology Unit, Department of Surgical Sciences, Tor Vergata University Hospital, University of Rome Tor Vergata, Rome, Italy
| |
Collapse
|
4
|
Diamand R, D'Hondt F, Mjaess G, Jabbour T, Dell'Oglio P, Larcher A, Moschini M, Quackels T, Peltier A, Assenmacher G, Wiklund P, Breda A, Turri F, De Groote R, Mottrie A, Roumeguere T, Albisinni S. Teaching robotic cystectomy: prospective pilot clinical validation of the ERUS training curriculum. BJU Int 2023. [PMID: 36815233 DOI: 10.1111/bju.15993] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
OBJECTIVE To provide the first clinical validation of the European Association of Urology Robotic Urology Section (ERUS) curriculum for training in robot-assisted radical cystectomy with intracorporeal urinary diversion (iRARC). PATIENTS AND METHODS The ERUS proposed a structured curriculum, divided into 11 steps, to train novice surgeons and help overcome the steep learning curve associated with iRARC. In this study, one trainee completed the curriculum under the mentorship of an expert. Twenty-one patients were operated on by the trainee following the proposed iRARC curriculum [(t)iRARC group] and were compared with 42 patients treated with the standard of care by the mentor [(m)iRARC group]. To evaluate curriculum safety, peri-operative outcomes, surgical margins and complications were assessed. Propensity-score matching (1:2) was used to identify comparable (t)iRARC and (m)iRARC cases. Matched variables included age, body mass index, neoadjuvant therapy, American Society of Anesthesiologists score and cT stage. Mann-Whitney and chi-squared tests were used to compare peri- and postoperative outcomes between the two cohorts. To evaluate curriculum efficacy, steps attempted and completed by the trainee were assessed and studied as a function of growing surgical experience of the trainee. RESULTS The trainee progressed in proficiency-based training through steps of increasing difficulty. No differences in estimated blood loss, positive soft tissue margins, number of resected lymph nodes, overall and high-grade complications, or 90-day readmissions between the (t)iRARC and (m)iRARC groups were observed (all P > 0.05). However, operating time was significantly longer in the (t)iRARC group (P = 0.01). Of the 209 available steps, the trainee attempted 168 (80%) and successfully performed 125 (60%). Increasing experience was associated with more steps being successfully performed (P < 0.001). CONCLUSIONS The proposed ERUS curriculum assists naïve surgeons during the learning curve for iRARC and should be encouraged in order to guarantee optimal outcomes during the learning phase of this procedure.
Collapse
Affiliation(s)
- Romain Diamand
- Urology Department, Hôpital Universitaire de Bruxelles, Université libre de Bruxelles, Brussels, Belgium
| | - Frederiek D'Hondt
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
- ORSI Academy, Melle, Belgium
| | - Georges Mjaess
- Urology Department, Hôpital Universitaire de Bruxelles, Université libre de Bruxelles, Brussels, Belgium
| | - Teddy Jabbour
- Urology Department, Hôpital Universitaire de Bruxelles, Université libre de Bruxelles, Brussels, Belgium
| | - Paolo Dell'Oglio
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alessandro Larcher
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Moschini
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Thierry Quackels
- Urology Department, Hôpital Universitaire de Bruxelles, Université libre de Bruxelles, Brussels, Belgium
| | - Alexandre Peltier
- Urology Department, Hôpital Universitaire de Bruxelles, Université libre de Bruxelles, Brussels, Belgium
| | - Gregoire Assenmacher
- Urology Department, Hôpital Universitaire de Bruxelles, Université libre de Bruxelles, Brussels, Belgium
| | - Peter Wiklund
- Department of Urology, Icahn School of Medicine, Mount Sinai, NY, USA
| | - Alberto Breda
- Departement of Urology, Fundacio Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Filippo Turri
- Unit of Urology - ASST Santi Paolo e Carlo - University La Statale, Milan, Italy
| | - Ruben De Groote
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
- ORSI Academy, Melle, Belgium
| | - Alexandre Mottrie
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
- ORSI Academy, Melle, Belgium
| | - Thierry Roumeguere
- Urology Department, Hôpital Universitaire de Bruxelles, Université libre de Bruxelles, Brussels, Belgium
| | - Simone Albisinni
- Urology Department, Hôpital Universitaire de Bruxelles, Université libre de Bruxelles, Brussels, Belgium
- Urology Unit, Department of Surgical Sciences, Tor Vergata University Hospital, University of Rome Tor Vergata, Rome, Italy
| | | |
Collapse
|
5
|
Sarkis J, Diamand R, Aoun F, Assenmacher G, Assenmacher C, Verhoest G, Holz S, Naudin M, Ploussard G, Mari A, Minervini A, Tay A, Issa R, Roumiguié M, Bajeot AS, Simone G, Anceschi U, Umari P, Sridhar A, Kelly J, Hendricksen K, Einerhand S, Mertens LS, Sanchez-Salas R, Colomer A, Quackels T, Peltier A, Montorsi F, Briganti A, Pradere B, Moschini M, Roumeguère T, Albisinni S. Do perioperative blood transfusions impact oncological outcomes of robot-assisted radical cystectomy with intracorporeal urinary diversion? Results from a large multi-institutional registry. Minerva Urol Nephrol 2023; 75:50-58. [PMID: 36800680 DOI: 10.23736/s2724-6051.22.05109-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
BACKGROUND Blood transfusions (BT) have been associated with adverse oncologic outcomes in multiple malignancies including open radical cystectomy (ORC) for urothelial carcinoma of the bladder (UCB). Robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) delivers similar oncologic outcomes compared to ORC, yet with lower blood loss and reduced transfusions. However, the impact of BT after robotic cystectomy is still unknown. METHODS This is a multicenter study including patients treated for UCB with RARC and ICUD in 15 academic institutions, between January 2015 and January 2022. BT were administered during surgery (intraoperative blood transfusions, iBT) or during the first 30 days after surgery (post-operative blood transfusions, pBT). The association of iBT and pBT with recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS) were evaluated by univariate and multivariate regression analysis. RESULTS A total of 635 patients were included in the study. Overall, 35/635 patients (5.51%) received iBT while 70/635 (11.0%) received pBT. After a mean follow-up of 23±18 months, 116 patients (18.3%) had died, including 96 (15.1%) from bladder cancer. Recurrence occurred in 146 patients (23%). iBT were associated with decreased RFS, CSS and OS (P<0.001) on univariate Cox analysis. After adjusting for clinicopathologic covariates, iBT were associated only with the risk of recurrence (HR: 1.7; 95% CI, 1.0-2.8, P=0.04). pBT were not significantly associated to RFS, CSS or OS on univariate and multivariate Cox regression models (P>0.05). CONCLUSIONS In the present study, patients treated by RARC with ICUD for UCB have a higher risk of recurrence after iBT, yet no significant association with CSS and OS was found. pBT are not associated with worse oncological prognosis.
Collapse
Affiliation(s)
- Julien Sarkis
- Department of Urology, Erasme Hospital, University Clinics of Brussels, Université Libre de Bruxelles, Brussels, Belgium -
| | - Romain Diamand
- Department of Urology, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Fouad Aoun
- Department of Urology, Hotel Dieu de France, Beirut, Lebanon
| | | | | | | | - Serge Holz
- Department of Urology, CHU Ambroise Paré, Mons, Belgium
| | - Michel Naudin
- Department of Urology, CHU Ambroise Paré, Mons, Belgium
| | - Guillaume Ploussard
- Department of Urology, La Croix du Sud Hospital, Quint-Fonsegrives, France.,Institut Universitaire du Cancer Toulouse - Oncopole, Toulouse, France
| | - Andrea Mari
- Department of Experimental and Clinical Medicine, Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi University Hospital, University of Florence, Florence, Italy
| | - Andrea Minervini
- Department of Experimental and Clinical Medicine, Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi University Hospital, University of Florence, Florence, Italy
| | - Andrea Tay
- Department of Urology, Saint Georges Hospital, London, UK
| | - Rami Issa
- Department of Urology, Saint Georges Hospital, London, UK
| | - Mathieu Roumiguié
- Department of Urology, Andrology and Renal Transplantation, CHU Rangueil, Paul-Sabatier University, Toulouse Cedex, France
| | - Anne S Bajeot
- Department of Urology, Andrology and Renal Transplantation, CHU Rangueil, Paul-Sabatier University, Toulouse Cedex, France
| | - Giuseppe Simone
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Umberto Anceschi
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Paolo Umari
- Division of Surgery and Interventional Sciences, University College of London, London, UK
| | - Ashwin Sridhar
- Division of Surgery and Interventional Sciences, University College of London, London, UK
| | - John Kelly
- Division of Surgery and Interventional Sciences, University College of London, London, UK
| | - Kees Hendricksen
- Department of Urology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Sarah Einerhand
- Department of Urology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Laura S Mertens
- Department of Urology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - Anna Colomer
- Department of Urology, Montsouris Mutualiste Institute, Paris, France
| | - Thierry Quackels
- Department of Urology, Erasme Hospital, University Clinics of Brussels, Université Libre de Bruxelles, Brussels, Belgium
| | - Alexandre Peltier
- Department of Urology, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Francesco Montorsi
- Division of Oncology, Unit of Urology, Urological Research Institute, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Division of Oncology, Unit of Urology, Urological Research Institute, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Department of Urology UROSUD, Croix Du Sud Hospital, Quint-Fonsegrives, France
| | - Marco Moschini
- Division of Oncology, Unit of Urology, Urological Research Institute, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Thierry Roumeguère
- Department of Urology, Erasme Hospital, University Clinics of Brussels, Université Libre de Bruxelles, Brussels, Belgium.,Department of Urology, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Simone Albisinni
- Department of Urology, Erasme Hospital, University Clinics of Brussels, Université Libre de Bruxelles, Brussels, Belgium.,Unit of Urology, Department of Surgical Sciences, Tor Vergata University Hospital, University of Rome Tor Vergata, Rome, Italy
| | | |
Collapse
|
6
|
Vierasu I, Van Simaeys G, Trotta N, Lacroix S, Bormans G, Albisinni S, Quackels T, Roumeguère T, Goldman S. 18F-JK-PSMA-7 PET/CT for staging intermediate- or high-risk prostate cancer patients before radical prostatectomy: a pilot study. Eur J Hybrid Imaging 2023; 7:2. [PMID: 36683076 PMCID: PMC9868215 DOI: 10.1186/s41824-022-00161-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/28/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Positron emission tomography/computed tomography (PET/CT) using radiotracers that bind to the prostate-specific membrane antigen (PSMA) is mainly used in biochemical recurring prostate cancer. The aim of our study was to assess the usefulness of 18F-JK-PSMA-7 PET/CT for local and nodal staging in patients with intermediate- and high-risk prostate cancer (PCa) prior to radical prostatectomy, as compared to conventional imaging techniques. METHODS We enrolled a total of 10 patients with intermediate- and high-risk PCa diagnosed by multiparametric-MRI followed by systematic and targeted biopsies, eligible for radical prostatectomy with extended lymph node dissection. Clinical team was blind to the results of the pre-surgery 18F-JK-PSMA-7 PET/CT at times of clinical decision and surgery. One month post-surgery, 18F-JK-PSMA-7 PET/CT was repeated and the results of both scans were unblinded. A third 18F-JK-PSMA-7 PET/CT could be acquired at a later time point depending on PSA progression. RESULTS All pre-surgery 18F-JK-PSMA-7 PET/CT was positive in the prostatic region, while MRI was negative in the prostate in one patient. We also detected positive pelvic lymph nodes in two patients (one high-risk, one intermediate-risk PCa) on pre-surgery and post-surgery 18F-JK-PSMA-7 PET/CT. No positive pelvic lymph nodes were reported on pre-surgical CT and MRI. 18F-JK-PSMA-7 PET/CT detected bladder involvement in one patient and seminal vesicles involvement in two patients; this malignant extension was undetected by the conventional imaging techniques. SUVmax in prostate lesions had an average value of 11.51 (range 6.90-21.49). SUVmean in prostate lesions had an average value of 7.59 (range 5.26-14.02). CONCLUSION This pilot study indicates that pre-surgery 18F-JK-PSMA-7 PET/CT provides valuable information in intermediate- and high-risk PCa, for surgery planning with curative intent.
Collapse
Affiliation(s)
- Irina Vierasu
- grid.4989.c0000 0001 2348 0746Nuclear Medicine Department & PET/Biomedical Cyclotron Unit, Hôpital Erasme, Université libre de Bruxelles (ULB), Route de Lennik 808, 1070 Brussels, Belgium
| | - Gaetan Van Simaeys
- grid.4989.c0000 0001 2348 0746Nuclear Medicine Department & PET/Biomedical Cyclotron Unit, Hôpital Erasme, Université libre de Bruxelles (ULB), Route de Lennik 808, 1070 Brussels, Belgium ,grid.4989.c0000 0001 2348 0746Center for Microscopy and Molecular Imaging (CMMI), Université libre de Bruxelles (ULB), Charleroi, Gosselies, Belgium
| | - Nicola Trotta
- grid.4989.c0000 0001 2348 0746Nuclear Medicine Department & PET/Biomedical Cyclotron Unit, Hôpital Erasme, Université libre de Bruxelles (ULB), Route de Lennik 808, 1070 Brussels, Belgium
| | - Simon Lacroix
- grid.4989.c0000 0001 2348 0746Nuclear Medicine Department & PET/Biomedical Cyclotron Unit, Hôpital Erasme, Université libre de Bruxelles (ULB), Route de Lennik 808, 1070 Brussels, Belgium ,grid.4989.c0000 0001 2348 0746Center for Microscopy and Molecular Imaging (CMMI), Université libre de Bruxelles (ULB), Charleroi, Gosselies, Belgium
| | - Guy Bormans
- grid.5596.f0000 0001 0668 7884Radiopharmaceutical Recherche, KU Leuven, Leuven, Belgium
| | - Simone Albisinni
- grid.4989.c0000 0001 2348 0746Urology Department, Cliniques Universitaires de Bruxelles, HUB, Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Thierry Quackels
- grid.4989.c0000 0001 2348 0746Urology Department, Cliniques Universitaires de Bruxelles, HUB, Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Thierry Roumeguère
- grid.4989.c0000 0001 2348 0746Urology Department, Cliniques Universitaires de Bruxelles, HUB, Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Serge Goldman
- grid.4989.c0000 0001 2348 0746Nuclear Medicine Department & PET/Biomedical Cyclotron Unit, Hôpital Erasme, Université libre de Bruxelles (ULB), Route de Lennik 808, 1070 Brussels, Belgium ,grid.4989.c0000 0001 2348 0746Center for Microscopy and Molecular Imaging (CMMI), Université libre de Bruxelles (ULB), Charleroi, Gosselies, Belgium
| |
Collapse
|
7
|
Anceschi U, Morelli M, Flammia RS, Brassetti A, Dell’Oglio P, Galfano A, Tappero S, Vecchio E, Martiriggiano M, Luciani LG, Sperduti I, Albisinni S, Tuderti G, Prata F, Ferriero MC, Bove AM, Mastroianni R, Spadaro G, Russo A, Mattevi D, Tufano A, Leonardo C, Lombardo R, De Nunzio C, Cai T, Quackels T, Bocciardi AM, Simone G. Predictors of trainees’ proficiency during the learning curve of robot-assisted radical prostatectomy at high-volume institutions: results from a multicentric series. Cent European J Urol 2023; 76:38-43. [PMID: 37064261 PMCID: PMC10091888 DOI: 10.5173/ceju.2023.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 03/08/2023] Open
Abstract
Introduction The aim of this series was to evaluate predictors of Proficiency score (PS) achievement on a multicentric series of robot-assisted radical prostatectomies (RARP) performed by trainee surgeons with two different surgical techniques at four tertiary-care centers. Material and methods Four institutional datasets were merged and queried for RARPs performed by surgeons during their learning curve (LC) between 2010 and 2020 using two different approaches (Group A, Retzius-sparing RARP, n = 164; Group B, standard anterograde RARP, n = 79). Logistic regression analysis was performed to identify predictors of PS achievement for the overall trainee cohort. For all analyses, a two-sided p <0.05 was considered significant. Results Group B showed significantly increased median operative time, positive surgical margins (PSM) status, increased number of nerve-sparing procedures, shorter LC time (each p <0.04). PS, continence status, potency, biochemical recurrence and 1-year trifecta rates were comparable between groups (each p >0.3). On multivariable analysis, time from LC starting ≥12 months (OR = 2.79; 95%IC [1.15-6.76]; p = 0.02) and a nerve-sparing intent (OR = 3.18; 95%IC [1.15-8.77]; p = 0.02) were independent predictors of PS score achievement (Table 3). Conclusions Higher PS rates for RARP trainees may be expected after 12 months from LC beginning. Short-term training courses are unlikely to confer proper surgical training, while long-term structured training programs seem to be beneficial on perioperative outcomes.
Collapse
Affiliation(s)
- Umberto Anceschi
- IRCCS ‘Regina Elena’ National Cancer Institute, Department of Urology, Rome, Italy
| | - Michele Morelli
- Ospedale Niguarda Ca’ Granda, Department of Urology, Milan, Italy
| | - Rocco Simone Flammia
- Sapienza University of Rome, Urologic Clinic, Department of Maternal, Child and Urologic Sciences, Rome, Italy
| | - Aldo Brassetti
- IRCCS ‘Regina Elena’ National Cancer Institute, Department of Urology, Rome, Italy
| | - Paolo Dell’Oglio
- Ospedale Niguarda Ca’ Granda, Department of Urology, Milan, Italy
| | - Antonio Galfano
- Ospedale Niguarda Ca’ Granda, Department of Urology, Milan, Italy
| | - Stefano Tappero
- Ospedale Niguarda Ca’ Granda, Department of Urology, Milan, Italy
| | - Enrico Vecchio
- Ospedale Niguarda Ca’ Granda, Department of Urology, Milan, Italy
| | | | | | - Isabella Sperduti
- IRCCS Regina Elena National Cancer Institute, Biostatistical Unit, Rome, Italy
| | - Simone Albisinni
- University of Bruxelles, Erasme Hospital, Service de Urologie, Bruxelles, Belgium
| | - Gabriele Tuderti
- IRCCS ‘Regina Elena’ National Cancer Institute, Department of Urology, Rome, Italy
| | - Francesco Prata
- IRCCS ‘Regina Elena’ National Cancer Institute, Department of Urology, Rome, Italy
| | | | - Alfredo Maria Bove
- IRCCS ‘Regina Elena’ National Cancer Institute, Department of Urology, Rome, Italy
| | - Riccardo Mastroianni
- IRCCS ‘Regina Elena’ National Cancer Institute, Department of Urology, Rome, Italy
| | - Giuseppe Spadaro
- IRCCS ‘Regina Elena’ National Cancer Institute, Department of Urology, Rome, Italy
| | - Andrea Russo
- IRCCS Regina Elena National Cancer Institute, Department of Research, Advanced Diagnostics and Technological Innovation, Pathology Unit, Rome, Italy
| | - Daniele Mattevi
- APSS, Santa Chiara Regional Hospital, Department of Urology, Trento, Italy
| | - Antonio Tufano
- Sapienza University of Rome, Urologic Clinic, Department of Maternal, Child and Urologic Sciences, Rome, Italy
| | - Costantino Leonardo
- Sapienza University of Rome, Urologic Clinic, Department of Maternal, Child and Urologic Sciences, Rome, Italy
| | - Riccardo Lombardo
- Sant' Andrea Hospital, ‘Sapienza’ University, Department of Urology, Rome, Italy
| | - Cosimo De Nunzio
- Sant' Andrea Hospital, ‘Sapienza’ University, Department of Urology, Rome, Italy
| | - Tommaso Cai
- APSS, Santa Chiara Regional Hospital, Department of Urology, Trento, Italy
| | - Thierry Quackels
- University of Bruxelles, Erasme Hospital, Service de Urologie, Bruxelles, Belgium
| | | | - Giuseppe Simone
- IRCCS ‘Regina Elena’ National Cancer Institute, Department of Urology, Rome, Italy
| |
Collapse
|
8
|
Sarkis J, Vannier E, Mjaess G, Pochet C, Albisinni S, Quackels T, Roumeguère T. Neoadjuvant immunochemotherapy in the treatment of nonmetastatic muscle-invasive bladder cancer: a systematic review. Immunotherapy 2022; 14:1407-1417. [PMID: 36448639 DOI: 10.2217/imt-2022-0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction: Multiple trials are currently studying the additional effect of immunotherapy on neoadjuvant chemotherapy (NAC) in nonmetastatic muscle-invasive bladder cancer. Methods: We performed a systematic review of the literature that summarizes all ongoing trials, with their results when available. Results: From an initial 269 trials identified, 17 were included. Pathological response and pathological complete response rates of the immunotherapy + NAC combination in the cisplatin-eligible population varied between 56.6-75% and 34.0-66.7%, respectively. Two studies published their results in the cisplatin-ineligible population, with pathological complete response rates of 18 and 45.2%. Conclusion: Neoadjuvant immunochemotherapy in platinum-eligible patients results in response rates higher than those reported for NAC alone. Strong preliminary results are still lacking in the platinum-ineligible population.
Collapse
Affiliation(s)
- Julien Sarkis
- Department of Urology, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Enguerrand Vannier
- Department of Urology, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Georges Mjaess
- Department of Urology, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Corentin Pochet
- Department of Urology, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Simone Albisinni
- Department of Surgical Sciences, Urology Unit, Tor Vergata University Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Thierry Quackels
- Department of Urology, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Thierry Roumeguère
- Department of Urology, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| |
Collapse
|
9
|
Anceschi U, Galfano A, Luciani L, Misuraca L, Albisinni S, Dell'oglio P, Tuderti G, Brassetti A, Ferriero MC, Bove AM, Mastroianni R, Petralia G, Secco S, DI Trapani E, Mattevi D, Puglisi M, Cai T, Quackels T, Malossini G, Bocciardi AM, Simone G. Analysis of predictors of early trifecta achievement after robot-assisted radical prostatectomy for trainers and expert surgeons: the learning curve never ends. Minerva Urol Nephrol 2022; 74:133-136. [PMID: 35345386 DOI: 10.23736/s2724-6051.22.04805-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Umberto Anceschi
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy -
| | - Antonio Galfano
- Department of Urology, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lorenzo Luciani
- Department of Urology, APSS Santa Chiara Regional Hospital, Trento, Italy
| | - Leonardo Misuraca
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Simone Albisinni
- Department of Urology, Erasme Hospital, University of Brussels, Brussels, Belgium
| | - Paolo Dell'oglio
- Department of Urology, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gabriele Tuderti
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Aldo Brassetti
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Maria C Ferriero
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Alfredo M Bove
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Riccardo Mastroianni
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giovanni Petralia
- Department of Urology, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvia Secco
- Department of Urology, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ettore DI Trapani
- Department of Urology, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniele Mattevi
- Department of Urology, APSS Santa Chiara Regional Hospital, Trento, Italy
| | - Marco Puglisi
- Department of Urology, APSS Santa Chiara Regional Hospital, Trento, Italy
| | - Tommaso Cai
- Department of Urology, APSS Santa Chiara Regional Hospital, Trento, Italy
| | - Thierry Quackels
- Department of Urology, Erasme Hospital, University of Brussels, Brussels, Belgium
| | - Gianni Malossini
- Department of Urology, APSS Santa Chiara Regional Hospital, Trento, Italy
| | - Aldo M Bocciardi
- Department of Urology, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giuseppe Simone
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| |
Collapse
|
10
|
Vierasu I, Trotta N, Albisinni S, Mathey C, Leurquin-Sterk G, Lacroix S, Van Simaeys G, Quackels T, Roumeguère T, Goldman S. Clinical experience with 18F-JK-PSMA-7 when using a digital PET/CT. Eur J Hybrid Imaging 2022; 6:6. [PMID: 35288807 PMCID: PMC8921393 DOI: 10.1186/s41824-022-00128-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/21/2022] [Indexed: 11/20/2022] Open
Abstract
Background Digital PET/CT systems make use of a new technology with higher sensitivity and other better technological features than the analog ones. They require adaptation of the trade-off between performance, tracer dose and acquisition time. The aim of the study was to explore the performance of 18F-JK-PSMA-7 imaging when performed on a digital PET/CT with an adapted protocol, in a population of patients with prostate cancer patients (PCa). Influence of previous therapy on PET/CT performance is generally disregarded in PSMA-based imaging, despite potential influence of hormono-chemotherapy on the target expression. This potential influence was also tested in this work. Methods A total of 54 PCa patients experiencing biochemical recurrence were included in the study, in which we analysed the diagnostic performance of digital 18F-JK-PSMA-7 PET/CT. Compared to our protocol applied for acquisition on an analog system, administered dose and acquisition time were reduced by 20% and 50% respectively. We specifically took into consideration the influence of previous treatments on recurrence detection. Results We detected overall 18F-JK-PSMA-7-positive lesions in 38/54 patients (70.3%). There was no statistically significant difference regarding the detection rate between the groups of patients who had hormono-chemotherapy any time after initial diagnosis and those who never got any hormonal or chemotherapeutic treatment. Regarding the SUV max values, there was not significant difference between the two groups of patients neither in pelvic ganglions nor in other metastatic sites or the prostate region. Conclusion 18F-JK-PSMA7 PET/CT with administered dose and acquisition time adapted to the digital technology provides valuable information in PCa patients with biochemical recurrence.
Collapse
|
11
|
Albisinni S, Diamand R, Mjaess G, Aoun F, Assenmacher G, Assenmacher C, Verhoest G, Holz S, Naudin M, Ploussard G, Mari A, Minervini A, Tay A, Issa R, Roumiguie M, Bajeot AS, Simone G, Anceschi U, Umari P, Sridhar A, Kelly J, Hendricksen K, Einerhand S, Sandel N, Sanchez-Salas R, Colore A, Quackels T, Peltier A, Montorsi F, Briganti A, Teoh JYC, Pradere B, Moschini M, Roumeguere T. Defining the morbidity of Robotic-Assisted Radical Cystectomy with Intracorporeal Urinary Diversion: adoption of the Comprehensive Complication Index. J Endourol 2022; 36:785-792. [PMID: 35109696 DOI: 10.1089/end.2021.0843] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND & OBJECTIVE The Clavien-Dindo Classification (CDC) only reports the post-operative complication of highest grade. It is thus of limited value for radical cystectomy after which patients usually experience multiple complications. The CCI is a novel scoring system which incorporates all post-operative events in one single value. To adopt the Comprehensive Complication Index (CCI) for the evaluation of complications in patients undergoing Robot-Assisted Radical Cystectomy (RARC) with Intra-Corporeal Urinary Diversion (ICUD) and explore its advantages in the analysis of the morbidity of RARC with ICUD. PATIENTS AND METHODS Multicentric cohort of 959 patients undergoing RARC+ICUD between 2015-2020, whose complications are encoded in local prospective registries. Post-operative complications at 30 days were assessed using both the CDC and CCI. The CCI was calculated using an online tool (assessurgery.com). Risk factors for overall, major complications (CDC≥III) and CCI were evaluated using uni- and multivariable logistic and linear regressions. To analyse the potential advantage of using the CCI in clinical trials, a sample size calculation of a hypothetic clinical trial was performed using as endpoint reduction of morbidity with either the CDC or CCI. RESULTS Overall, 885 post-operative complications were reported in 507 patients (53%). The CCI improved the definition of post-operative morbidity in 22.6% of patients. Male sex and neobladder were associated to major complications and to a significant increase in CCI on adjusted regressions. In a hypothetical clinical trial, 80 patients would be needed to demonstrate a ten point reduction in CCI, compared to 186 needed to demonstrate an absolute risk reduction of 20% in overall morbidity using the CDC. CONCLUSION CCI improves the evaluation of post-operative morbidity by considering the cumulative aspect of complications compared to the CDC. Implementing the CCI for radical cystectomy would help reducing sample sizes in clinical trials.
Collapse
Affiliation(s)
- Simone Albisinni
- Hopital Erasme, 70496, Route de Lennik 808, Bruxelles, Belgium, 1070;
| | - Romain Diamand
- Institut Jules Bordet, 60210, Bruxelles, Bruxelles, Belgium;
| | | | | | | | | | | | - Serge Holz
- Ambroise Pare Ziekenhuis, 82241, Mons, Wallonie, Belgium;
| | - Michel Naudin
- Ambroise Pare Ziekenhuis, 82241, Mons, Wallonie, Belgium;
| | - Guillaume Ploussard
- Clinique Capio La Croix du Sud, 538719, Quint-Fonsegrives, Occitanie, France;
| | - Andrea Mari
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy., Urology, Largo Brambilla 3, Firenze, Italy, 50100.,University of Florence, Careggi Hospital, Florence, Italy.;
| | - Andrea Minervini
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy., Urology, Clinica Urologica I, Azienda Ospedaliera Careggi, Università di Firenze., Largo Brambilla 3 - San Luca Nuovo Padiglione 16/Settore C/Piano II, Florence, Italy, 50134;
| | - Andrea Tay
- St George's Healthcare NHS Trust, 4968, London, London, United Kingdom of Great Britain and Northern Ireland;
| | - Rami Issa
- St George's Healthcare NHS Trust, 4968, London, London, United Kingdom of Great Britain and Northern Ireland;
| | | | | | - Giuseppe Simone
- Regina Elena, urology, via elio chianesi 53, Roma, Italy, 00144.,Italy;
| | | | - Paolo Umari
- University of Eastern Piedmont Amedeo Avogadro Department of Translational Medicine, 370891, Department of Urology, Via Solaroli 17, 28100, Novara, Italy, Novara, Italy, 28100.,United States;
| | - Ashwin Sridhar
- UCLH, 8964, London, London, United Kingdom of Great Britain and Northern Ireland;
| | - John Kelly
- UCLH, 8964, London, London, United Kingdom of Great Britain and Northern Ireland;
| | - Kees Hendricksen
- Netherlands Cancer Institute, 1228, Amsterdam, Noord-Holland, Netherlands;
| | - Sarah Einerhand
- Netherlands Cancer Institute, 1228, Amsterdam, Noord-Holland, Netherlands;
| | - Noah Sandel
- Netherlands Cancer Institute, 1228, Amsterdam, Noord-Holland, Netherlands;
| | - Rafael Sanchez-Salas
- Institute Mutualiste Monsouris, Urology, 142, Bd. Jourdan, Paris, Not Applicable, France, 75014;
| | - Anne Colore
- Institut Mutualiste Montsouris, 26953, Paris, Île-de-France, France;
| | | | | | | | | | - Jeremy Y C Teoh
- Prince of Wales Hospital, Surgery, 30-32 Ngan Shing Street, Shatin, New Territories., Hong Kong, Hong Kong;
| | - Benjamin Pradere
- Medical University of Vienna, 27271, Department of urology, Wien, Wien, Austria;
| | - Marco Moschini
- Luzerner Kantonsspital, 30748, Luzern, Switzerland.,Vita-Salute University, urology, Milan, Italy;
| | - Thierry Roumeguere
- Hôpital Erasme, 70496, Urology, route de Lennik 808, Bruxelles, Belgium, 1070.,United States;
| |
Collapse
|
12
|
Anceschi U, Galfano A, Dell'Oglio P, Bravi C, Misuraca L, Tuderti G, Ferriero M, Albisinni S, Luciani L, Secco S, Petralia G, Di Trapani E, Brassetti A, Mastroianni R, Bove A, Ferriero M, Cai T, Puglisi M, Mattevi D, Quackels T, Malossini G, Bocciardi A, Simone G. Assessing the quality of learning curve through a standardized proficiency score and the impact of learning curve on trifecta outcomes of robot-assisted radical prostatectomy (RALP): Results of a multicentric series. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01223-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
13
|
Pochet C, Mjaess G, Moyson J, Quackels T, Roumeguere T, Albisinni S. Application of the comprehensive complication index to a cost-prediction model for radical cystectomy: Preliminary analysis. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00094-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
14
|
Albisinni S, Diamand R, Mjaess G, Assenmacher G, Assenmacher C, Loos S, Verhoest G, Holz S, Naudin M, Ploussard G, Mari A, Di Maida F, Minervini A, Aoun F, Tay A, Issa R, Roumiguié M, Bajeot AS, Simone G, Anceschi U, Umari P, Sridhar A, Kelly J, Hendricksen K, Einerhand S, Sanchez-Salas R, Colomer A, Quackels T, Peltier A, Montorsi F, Briganti A, Pradere B, Moschini M, Roumeguère T. Continuing acetylsalicylic acid during Robotic-Assisted Radical Cystectomy with intracorporeal urinary diversion does not increase hemorrhagic complications: results from a large multicentric cohort. Urol Oncol 2021; 40:163.e11-163.e17. [PMID: 34580028 DOI: 10.1016/j.urolonc.2021.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/26/2021] [Accepted: 08/23/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate whether continuing the antiplatelet drug acetylsalicylic acid≤100mg (ASA) during Robotic-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) increases the risk of peri-and postoperative hemorrhagic complications and overall morbidity. Indeed, guidelines recommend interrupting antiplatelet therapy before radical cystectomy; however, RARC with ICUD is associated to reduced estimated blood loss and blood transfusions compared to its open counterpart. METHODS Data from a multicentric European database were analyzed. All participating centers maintained a prospective database of patients undergoing RARC with ICUD. We identified patients receiving antiplatelet therapy by acetylsalicylic acid ≤100mg. Patients were divided into three groups: those not taking acetylsalicylic acid (no-ASA), those where ASA was continued perioperatively (c-ASA) and those where ASA was interrupted perioperatively (i-ASA). Estimated blood loss and peri-and post-operative transfusions were recorded. Hemorrhagic complications, ischemic, thrombotic and cardiac morbidity was recorded and classified using the Clavien-Dindo score by a senior urologist. RESULTS 640 patients were analyzed. Patients on acetylsalicylic acid were significantly older and had more comorbidities. No significant difference was found for estimated blood loss between no-ASA, c-ASA and i-ASA (280 vs. 300 vs. 200ml respectively; P = 0.09). Similarly, no significant difference was found for intraoperative (5% vs. 9% vs. 11%; P = 0.07) and postoperative transfusion rate (11% vs. 13% vs. 18%; P = 0.17). Higher ischemic complications were noted in the i-ASA group compared to no-ASA and c-ASA (4% vs. 0.6% vs. 1.4%; P = 0.03). On uni and multivariate logistic regression, continuing acetylsalicylic acid was not significantly associated to either major complications or post-operative transfusions. CONCLUSIONS Peri-operative acetylsalicylic acid continuation in RARC with ICUD does not increase hemorrhagic complications. Interrupting acetylsalicylic acid peri-operatively may expose patients to a higher risk of ischemic events.
Collapse
Affiliation(s)
- Simone Albisinni
- Department of Urology, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
| | - Romain Diamand
- Department of Urology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Georges Mjaess
- Department of Urology, Hotel Dieu de France, Beirut, Lebanon
| | | | | | - Shirley Loos
- Department of Urology, Cliniques de l'Europe-Saint Elisabeth, Brussels, Belgium
| | | | - Serge Holz
- Department of Urology, CHU Ambroise Paré, Mons, Belgium
| | - Michel Naudin
- Department of Urology, CHU Ambroise Paré, Mons, Belgium
| | - Guillaume Ploussard
- Department of Urology, La Croix du Sud Hospital, Institut Universitaire du Cancer Toulouse - Oncopole, Toulouse, France
| | - Andrea Mari
- Department of Experimental and Clinical Medicine, Unit of Oncologic Minimally-Invasive Urology and Andrology, University of Florence, Careggi University Hospital, Florence, Italy
| | - Fabrizio Di Maida
- Department of Experimental and Clinical Medicine, Unit of Oncologic Minimally-Invasive Urology and Andrology, University of Florence, Careggi University Hospital, Florence, Italy
| | - Andrea Minervini
- Department of Experimental and Clinical Medicine, Unit of Oncologic Minimally-Invasive Urology and Andrology, University of Florence, Careggi University Hospital, Florence, Italy
| | - Fouad Aoun
- Department of Urology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Department of Urology, Hotel Dieu de France, Beirut, Lebanon
| | - Andrea Tay
- Department of Urology, Saint Georges Hospital, London, UK
| | - Rami Issa
- Department of Urology, Saint Georges Hospital, London, UK
| | - Mathieu Roumiguié
- Department of Urology, Andrology and Renal Transplantation, CHU Rangueil, Paul-Sabatier University, Toulouse Cedex, France
| | - Anne Sophie Bajeot
- Department of Urology, Andrology and Renal Transplantation, CHU Rangueil, Paul-Sabatier University, Toulouse Cedex, France
| | - Giuseppe Simone
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
| | - Umberto Anceschi
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
| | - Paolo Umari
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Ashwin Sridhar
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - John Kelly
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Kees Hendricksen
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Sarah Einerhand
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Anna Colomer
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | - Thierry Quackels
- Department of Urology, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Alexandre Peltier
- Department of Urology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Francesco Montorsi
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Marco Moschini
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Thierry Roumeguère
- Department of Urology, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium; Department of Urology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| |
Collapse
|
15
|
Devlies W, Silversmit G, De Coster G, Van Damme N, Van Eycken L, Roumeguère T, Quackels T, Van Cleynenbreugel B, Dekuyper P, Ameye F, Everaerts W, Joniau S. Be-RALP study: The effect of adjuvant treatment on quality of life, erectile function and continence. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01539-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
16
|
Diamand R, Ploussard G, Roumiguié M, Oderda M, Benamran D, Fiard G, Quackels T, Assenmacher G, Simone G, Van Damme J, Malavaud B, Iselin C, Descotes J, Roche J, Peltier A, Roumeguère T, Albisinni S. Validation externe du nomogramme basé sur l’imagerie par résonance magnétique prédisant le risque d’effraction extra-capsulaire et d’invasion des vésicules séminales chez des patients opérés de prostatectomie radicale. Prog Urol 2020. [DOI: 10.1016/j.purol.2020.07.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
17
|
Diamand R, Ploussard G, Roumiguié M, Oderda M, Benamran D, Fiard G, Peltier A, Simone G, Van Damme J, Malavaud B, Iselin C, Descotes J, Roche J, Quackels T, Roumeguère T, Albisinni S. Le délais pour une prostatectomie radicale n’influence pas le résultat ontologique : étude d’une large cohorte de patients européen. Prog Urol 2020. [DOI: 10.1016/j.purol.2020.07.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
18
|
Diamand R, Ploussard G, Roumiguié M, Oderda M, Benamran D, Fiard G, Quackels T, Assenmacher G, Simone G, Van Damme J, Malavaud B, Iselin C, Descotes JL, Roche JB, Peltier A, Roumeguère T, Albisinni S. External Validation of a Multiparametric Magnetic Resonance Imaging-based Nomogram for the Prediction of Extracapsular Extension and Seminal Vesicle Invasion in Prostate Cancer Patients Undergoing Radical Prostatectomy. Eur Urol 2020; 79:180-185. [PMID: 33023770 DOI: 10.1016/j.eururo.2020.09.037] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 09/19/2020] [Indexed: 01/07/2023]
Abstract
The nomogram reported by Gandaglia et al (The key combined value of multiparametric magnetic resonance imaging, and magnetic resonance imaging-targeted and concomitant systematic biopsies for the prediction of adverse pathological features in prostate cancer patients undergoing radical prostatectomy. Eur Urol 2020;77:733-41) predicting extracapsular extension (ECE) or seminal vesicle invasion (SVI) has been developed using multiparametric magnetic resonance imaging (MRI) parameters and MRI-targeted biopsy. We aimed to validate this nomogram externally by analyzing 566 patients harboring prostate cancer diagnosed on MRI-targeted biopsy followed by radical prostatectomy. At final pathology, 37% and 12% patients had ECE and SVI, respectively. Performance of the nomogram, in comparison with the Memorial Sloan Kettering Cancer Center (MSKCC) model and Partin tables, was evaluated using discrimination, calibration, and decision curve analysis. Regarding ECE prediction, the nomogram showed higher discrimination (71.8% vs 69.8%, p = 0.3 and 71.8% vs 61.3%, p < 0.001), and similar miscalibration and net benefit for probability threshold above 30% when compared with MSKCC model and Partin tables, respectively. Performance of the nomogram with regard to SVI was comparable in terms of discrimination (68.5% vs 70.4% vs 67.8%, p ≥ 0.6), presenting a slight overestimation on calibration plots and a net benefit for probability threshold above 7.5%. This is the first multicentric study that externally validates a nomogram predicting ECE and SVI in patients diagnosed with MRI-targeted biopsy. Its performance was less optimistic than expected, and implementation of MRI in this setting was not associated with a clear improvement in patient selection and clinical usefulness when compared with available models. We proposed an updated version of the nomogram predicting ECE using the recalibration method, which leads to an improvement in its performance and needs to be validated in another external set. PATIENT SUMMARY: We validate a prediction tool based on multiparametric magnetic resonance imaging (MRI) parameters and MRI-targeted biopsy predicting extracapsular extension and seminal vesicle invasion at radical prostatectomy. An improvement of patient selection was not clearly demonstrated when compared with available models based on clinical parameters, and implementation of MRI in this setting still needs to be clarified.
Collapse
Affiliation(s)
- Romain Diamand
- Urology Department, Hôpital Erasme, University Clinics of Brussels, Université Libre de Bruxelles, Brussels, Belgium.
| | | | | | - Marco Oderda
- Urology Department, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Daniel Benamran
- Urology Department, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Gaelle Fiard
- Urology Department, CHU de Grenoble, Grenoble, France; Grenoble Alpes University, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France
| | - Thierry Quackels
- Urology Department, Hôpital Erasme, University Clinics of Brussels, Université Libre de Bruxelles, Brussels, Belgium
| | - Grégoire Assenmacher
- Urology Department, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Giuseppe Simone
- Urology Department, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Julien Van Damme
- Urology Department, University Clinics Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Bernard Malavaud
- Urology Department, Institut Universitaire du Cancer Toulouse-Oncopole, Toulouse, France
| | - Christophe Iselin
- Urology Department, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Jean-Luc Descotes
- Urology Department, CHU de Grenoble, Grenoble, France; Grenoble Alpes University, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France
| | | | - Alexandre Peltier
- Urology Department, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Thierry Roumeguère
- Urology Department, Hôpital Erasme, University Clinics of Brussels, Université Libre de Bruxelles, Brussels, Belgium; Urology Department, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Simone Albisinni
- Urology Department, Hôpital Erasme, University Clinics of Brussels, Université Libre de Bruxelles, Brussels, Belgium
| |
Collapse
|
19
|
Diamand R, Ploussard G, Roumiguié M, Oderda M, Benamran D, Fiard G, Peltier A, Simone G, Van Damme J, Malavaud B, Iselin C, Descotes JL, Roche JB, Quackels T, Roumeguère T, Albisinni S. Timing and delay of radical prostatectomy do not lead to adverse oncologic outcomes: results from a large European cohort at the times of COVID-19 pandemic. World J Urol 2020; 39:1789-1796. [PMID: 32776243 PMCID: PMC7416303 DOI: 10.1007/s00345-020-03402-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/03/2020] [Indexed: 11/03/2022] Open
Abstract
PURPOSE The current COVID-19 pandemic is transforming our urologic practice and most urologic societies recommend to defer any surgical treatment for prostate cancer (PCa) patients. It is unclear whether a delay between diagnosis and surgical management (i.e., surgical delay) may have a detrimental effect on oncologic outcomes of PCa patients. The aim of the study was to assess the impact of surgical delay on oncologic outcomes. METHODS Data of 926 men undergoing radical prostatectomy across Europe for intermediate and high-risk PCa according to EAU classification were identified. Multivariable analysis using binary logistic regression and Cox proportional hazard model tested association between surgical delay and upgrading on final pathology, lymph-node invasion (LNI), pathological locally advanced disease (pT3-4 and/or pN1), need for adjuvant therapy, and biochemical recurrence. Kaplan-Meier analysis was used to estimate BCR-free survival after surgery as a function of surgical delay using a 3 month cut-off. RESULTS Median follow-up and surgical delay were 26 months (IQR 10-40) and 3 months (IQR 2-5), respectively. We did not find any significant association between surgical delay and oncologic outcomes when adjusted to pre- and post-operative variables. The lack of such association was observed across EAU risk categories. CONCLUSION Delay of several months did not appear to adversely impact oncologic results for intermediate and high-risk PCa, and support an attitude of deferring surgery in line with the current recommendation of urologic societies.
Collapse
Affiliation(s)
- Romain Diamand
- Urology Department, Hôpital Erasme, University Clinics of Brussels, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium.
| | | | | | - Marco Oderda
- Urology Department, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Daniel Benamran
- Urology Department, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Gaelle Fiard
- Urology Department, CHU de Grenoble, Grenoble, France.,Grenoble Alpes University, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France
| | | | - Giuseppe Simone
- Urology Department, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Julien Van Damme
- Urology Department, University Clinics Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Bernard Malavaud
- Urology Department, Institut Universitaire du Cancer Toulouse-Oncopole, Toulouse, France
| | - Christophe Iselin
- Urology Department, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Jean-Luc Descotes
- Urology Department, CHU de Grenoble, Grenoble, France.,Grenoble Alpes University, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France
| | | | - Thierry Quackels
- Urology Department, Hôpital Erasme, University Clinics of Brussels, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium
| | - Thierry Roumeguère
- Urology Department, Hôpital Erasme, University Clinics of Brussels, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium
| | - Simone Albisinni
- Urology Department, Hôpital Erasme, University Clinics of Brussels, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium
| |
Collapse
|
20
|
Draulans C, Van Damme N, Isebaert S, Everaerts W, Silversmit G, Joniau S, De Meerleer G, Van Eycken E, Haustermans K, Ameye F, Joniau S, Roumeguère T, Dekuyper P, Quackels T, Van Cleynenbreugel B. Variation in adjuvant and early salvage radiotherapy after robot-assisted radical prostatectomy for prostate cancer: a population-based cohort study. Acta Oncol 2020; 59:904-910. [PMID: 32723224 DOI: 10.1080/0284186x.2020.1759824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Purpose: The primary aim of the study was to assess the association between having a radiotherapy (RT) department on-site at the surgical centre and the performed postoperative treatment strategy for prostate cancer (PCa) patients. According to the current international guidelines, adjuvant radiotherapy (ART) or a regular prostate-specific antigen (PSA)-based follow-up with (early) salvage radiotherapy ((e)SRT) if needed is recommended in case of adverse pathological characteristics.Material and methods: Prospective data on consecutive robot-assisted radical prostatectomy (RARP) patients in Belgium from 2009 to 2016 were identified in the Belgian Robotic-Assisted-Laparoscopic-Prostatectomy (Be-RALP) database. Multivariable regression was used to evaluate patient- and facility-related factors associated with postoperative radiation treatment.Results: 2072 patients undergoing a RARP, suffering at least one of the following adverse pathological features, i.e., extracapsular extension (ECE), seminal vesicle invasion (SVI) or positive section margins (PSM), and with registered follow-up until 24 months were enrolled. After RARP, ART was applied to 9.1% and (e)SRT to 12.6% of the patients. Multivariable analysis demonstrated that patients were more likely to receive ART or (e)SRT if they were operated in a hospital with a RT department on-site (odds ratio, ART: 1.49 [1.07-2.07]; (e)SRT: 1.55 [1.16-2.06]). Furthermore, the presence of higher tumour category (T-category) and/or PSM on final pathology was associated with a higher chance of getting ART and (e)SRT (p < .01).Conclusion: Variations in ART and (e)SRT are not only driven by patient-related characteristics. In our nationwide cohort, the availability of a RT department on-site at the surgical centre was found to be an independent predictor for ART and (e)SRT, with a 1.5 times higher odds of receiving postoperative RT during the first 24 months after surgery.
Collapse
Affiliation(s)
- Cédric Draulans
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
- Department of Oncology, KU Leuven, Leuven, Belgium
| | | | - Sofie Isebaert
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
- Department of Oncology, KU Leuven, Leuven, Belgium
| | - Wouter Everaerts
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | | | - Steven Joniau
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Gert De Meerleer
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
- Department of Oncology, KU Leuven, Leuven, Belgium
| | | | - Karin Haustermans
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
- Department of Oncology, KU Leuven, Leuven, Belgium
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Soenens C, Dekuyper P, De Coster G, Van Damme N, Van Eycken E, Quackels T, Roumeguère T, Van Cleynenbreugel B, Joniau S, Ameye F. Concordance Between Biopsy and Radical Prostatectomy Gleason Scores: Evaluation of Determinants in a Large-Scale Study of Patients Undergoing RARP in Belgium. Pathol Oncol Res 2020; 26:2605-2612. [PMID: 32632897 DOI: 10.1007/s12253-020-00860-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 06/23/2020] [Indexed: 11/29/2022]
Abstract
To determine whether Gleason scores were concordant between prostate biopsies (bGS) and the definitive resection specimen (pGS) excised with robot-assisted radical prostatectomy (RARP); to identify clinical and pathological factors that might predict upgrading; and to evaluate how upgrading affected outcome. Between 2009 and 2016, 25 Belgian centers participated in collecting prospective data for patients that underwent RARP. We analyzed the concordance rate between the bGS and the pGS in 8021 patients with kappa statistics, and we compared concordance rates from different centers. We assessed the effect of several clinical and pathological factors on the concordance rate with logistic regression analysis. The concordance rate for the entire population was 62.9%. Upgrading from bGS to pGS occurred in 27.3% of patients. The number of biopsies was significantly associated with concordance. Older age (>60 y), a higher clinical T stage (≥cT2), a higher PSA value at the time of biopsy (>10 ng/ml), and more time between the biopsy and the radical prostatectomy were significantly associated with a higher risk of upgrading. Positive margins and PSA relapse occurred more frequently in upgraded patients. Center size did not significantly affect the concordance rate (p = 0.40).This prospective, nationwide analysis demonstrated a Gleason score concordance rate of 62.9%. Upgrading was most frequently observed in the non-concordant group. We identified clinical and pathological factors associated with (non)-concordance. Upgrading was associated with a worse oncological outcome. Center volume was not associated with pathological accuracy.
Collapse
Affiliation(s)
- C Soenens
- Department of Urology, AZ Maria Middelares, Ghent, Belgium.
| | - P Dekuyper
- Department of Urology, AZ Maria Middelares, Ghent, Belgium
| | | | | | | | - T Quackels
- Department of Urology, Erasmus Hospital, Brussels, Belgium
| | - T Roumeguère
- Department of Urology, Erasmus Hospital, Brussels, Belgium
| | | | - S Joniau
- Department of Urology, University Hospital of Leuven, Leuven, Belgium
| | - F Ameye
- Department of Urology, AZ Maria Middelares, Ghent, Belgium
| | | |
Collapse
|
22
|
Tosco L, Devos G, De Coster G, Roumeguère T, Everaerts W, Quackels T, Dekuyper P, Van Cleynenbreugel B, Van Damme N, Van Eycken E, Ameye F, Joniau S. Development and external validation of a nomogram to predict lymph node invasion after robot assisted radical prostatectomy. Urol Oncol 2019; 38:37.e11-37.e20. [PMID: 31727561 DOI: 10.1016/j.urolonc.2019.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/30/2019] [Accepted: 10/02/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Prediction of lymph node invasion (LNI) after radical prostatectomy has been rarely assessed in robotically assisted laparoscopic radical prostatectomy (RALP) series. We aimed to develop and externally validate a pretreatment nomogram for the prediction of LNI following RALP in patients with high- and intermediate-risk prostate cancer. METHODS 1654 RALP patients were prospectively collected between 2009 and 2016 from academic and community hospitals. We included patients with intermediate- and high-risk prostate cancer who underwent pelvic lymph node dissection (e-PLND). Logistic regression analysis was applied to construct a nomogram to predict LNI. Centers were randomly assigned to the training cohort (80%) and validation cohort (20%). The discriminative accuracies were evaluated by the areas under the curve and by the calibration plot. The net benefit of the nomogram to predict LNI was assessed by decision curve analysis and a cut-off was proposed. RESULTS In total, 14% of the patients in our cohort had pN1 disease. Applying logistic regression analysis, the following covariates were chosen to develop the nomogram: initial PSA, clinical T stage, biopsy Gleason sum, and proportion of positive biopsy cores. The nomogram showed a median discriminative accuracy of 73% and excellent calibration. The net benefit of the model ranged between 7% and 51% predicted risk of LNI. A cut-off to perform e-PLND was set at 7%. This would permit a 29% of avoidable e-PLND, missing 9.4% of patients with LNI. CONCLUSIONS We developed and externally validated a nomogram to predict LNI in patients treated with RALP from a prospective, multi-institutional, nationwide series. A risk of LNI > 7% is proposed as cut-off above which e-PLND is recommended.
Collapse
Affiliation(s)
- Lorenzo Tosco
- Urology, University Hospitals Leuven, Leuven, Belgium; Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele - Milan, Italy.
| | - Gaëtan Devos
- Urology, University Hospitals Leuven, Leuven, Belgium
| | | | - Thierry Roumeguère
- Department of Urology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Thierry Quackels
- Department of Urology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Peter Dekuyper
- Department of Urology, AZ Maria Middelares, Gent, Belgium
| | | | | | | | - Filip Ameye
- Department of Urology, AZ Maria Middelares, Gent, Belgium
| | - Steven Joniau
- Urology, University Hospitals Leuven, Leuven, Belgium
| | | |
Collapse
|
23
|
El kaddouri H, Doerfler A, Broeders N, Nortier J, Lemoine A, Quackels T, Roumeguère T. Cancer de la vessie et transplantation rénale. Prog Urol 2019. [DOI: 10.1016/j.purol.2019.08.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
24
|
Albisinni S, Pretot D, Al Hajj Obeid W, Aoun F, Quackels T, Peltier A, Roumeguère T. The impact of neutrophil-to-lymphocyte, platelet-to-lymphocyte and haemoglobin-to-platelet ratio on localised renal cell carcinoma oncologic outcomes. Prog Urol 2019; 29:423-431. [PMID: 31196826 DOI: 10.1016/j.purol.2019.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 03/04/2019] [Accepted: 05/18/2019] [Indexed: 12/21/2022]
Abstract
INTRODUCTION The neutrophil to lymphocyte ratio (NLR) and the platelet to lymphocyte ratio (PLR) are established markers of systemic inflammation. Moreover, anemia is a known adverse prognostic factor and reduced haemoglobin to platelet ratio (HPR) seems associate to poor outcomes in urothelial cancer. Aim of the current study was to explore the prognostic value of NLR, HPR and PLR in patients harboring localized RCC. Materials and Methods 184 patients undergoing partial and radical nephrectomy for renal mass in a single hospital were retrospectively analyzed. Uni- and multivariate logistic regressions were performed to assess associations between various risk factors, including NLR, PLR and HPR and locally advanced disease (≤pT2 vs.≥pT3) and tumor grade. Kaplan Meier curves and Cox regressions were constructed to assess the association of NLR, PLR and HPR to recurrence free survival (RFS), cancer specific survival (CSS) and overall survival (OS). To determine thresholds for variables, we considered the 75th percentile of our distribution of values, which was computed at 3.45 for NLR, 189 for PLR and 0.48 for HPR. A two-sided P<0.05 defined statistical significance. RESULTS Patients with an elevated NLR (>3.45) were more likely to present with≥pT3 stage (p=0.046). RFS was significantly different according to NLR value, with patients having an NLR>3.45 experiencing significantly worst RFS (P=0.019); similarly, an increased PLR was significantly associated to a reduced RFS (P=0.012). Restricting the Cox regression to patients with locally advanced disease (≥pT3), NLR was even more associated to recurrence (HR 3.22; 95%CI: 1.06-9.81, P=0.039). Patients exhibiting an NLR>3.45 (p=0.03) or a PLR>189 (P=0.005) did have a significantly worse CSS, while a HPR<0.48 did not predict CSS (P=0.12) on Kaplan Meier curves. Finally, an increased NLR (P=0.047), increased PLR (P=0.0006) and decreased HPR (P=0.05) were all associated to a poor overall survival on univariate analysis. On multivariate analysis, only HPR remained significantly predictive of OS (HR 0.077; 95%CI: 0.02-0.37, P=0.001). CONCLUSIONS In this single-center study analyzing non-metastatic RCC, an increased NLR was significantly associated to a reduced RFS, CSS and OS on univariate analyses and to RFS on multivariate analysis. Larger prospective studies are needed to validate our findings. LEVEL OF EVIDENCE 4.
Collapse
Affiliation(s)
- S Albisinni
- Urology Department, université libre de Bruxelles, University Clinics of Brussels, hôpital Erasme, route de Lennik 808, Brussels, Belgium.
| | - D Pretot
- Urology Department, université libre de Bruxelles, University Clinics of Brussels, hôpital Erasme, route de Lennik 808, Brussels, Belgium
| | - W Al Hajj Obeid
- Urology Department, université libre de Bruxelles, University Clinics of Brussels, hôpital Erasme, route de Lennik 808, Brussels, Belgium; Urology Department, Saint George Hospital University Medical Center, Beyrouth, Lebanon
| | - F Aoun
- Urology Department, Institute Jules Bordet, Université libre de Bruxelles, Brussels, Belgium; Urology Department, Hôtel-Dieu de France, université Saint Joseph, Beyrouth, Lebanon
| | - T Quackels
- Urology Department, université libre de Bruxelles, University Clinics of Brussels, hôpital Erasme, route de Lennik 808, Brussels, Belgium
| | - A Peltier
- Urology Department, Institute Jules Bordet, Université libre de Bruxelles, Brussels, Belgium
| | - T Roumeguère
- Urology Department, université libre de Bruxelles, University Clinics of Brussels, hôpital Erasme, route de Lennik 808, Brussels, Belgium
| |
Collapse
|
25
|
Albisinni S, Aoun F, Quackels T, Assenmacher G, Peltier A, van Velthoven R, Roumeguère T. Validated Prospective Assessment of Quality of Life After Robot-Assisted Laparoscopic Prostatectomy: Beyond Continence and Erections. Am J Mens Health 2019; 13:1557988319854555. [PMID: 31148505 PMCID: PMC6545668 DOI: 10.1177/1557988319854555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Continence and erectile function represent major concerns after robot-assisted laparoscopic prostatectomy (RALP), although the analysis of only these results may underestimate the impact of surgery on quality of life (QoL). The aim of the study is to prospectively analyze QoL after RALP according to the validated European Organization for Research and Treatment of Cancer Quality of Life Questionnaire prostate cancer-specific module (EORTC-QLQ-PR25) and C30 and explore risk factors for the deterioration of QoL after surgery. A total of 584 patients undergoing RALP were prospectively enrolled. QoL was assessed with the validated EORTC-QLQ-PR25 and C30. Differences across QoL items were assessed via Wilcoxon rank-sum test and associations between risk factors and QoL scores were tested via univariate and multivariate linear regression analyses. All items of the PR25 questionnaire showed a significant deterioration at 1 month after RALP and began to normalize 3 months after surgery. At 24 months follow-up, urinary, bowel, and sexual activity scores were not significantly different from preoperative scores, while incontinence aid, treatment-related symptoms, and sexual functioning remained significantly worse. Preoperative sexual activity was more important in determining 3-month sexual outcomes than preoperative 5-item version of the International Index of Erectile Function (IIEF-5) or nerve-sparing approach. An overall return to preoperative QoL was registered at 3 months after RALP in global and physical QoL, and most important, global, physical, social, and role-functioning QoL scores were improved at 12 and 24 months compared to preoperative scores. In this prospective study, detailed data on QoL are reported via the EORTC-PR25 and C30 questionnaires. While urinary, bowel, and sexual activity scores return to baseline values 24 months after surgery, incontinence aid, treatment-related symptoms, and sexual functioning may remain significantly deteriorated. Larger studies are needed to validate these findings.
Collapse
Affiliation(s)
- Simone Albisinni
- 1 Department of Urology, Hopital Erasme, Université Libre de Bruxelles, Belgium
| | - Fouad Aoun
- 2 Department of Urology, Institut Jules Bordet, Université Libre de Bruxelles, Belgium
| | - Thierry Quackels
- 1 Department of Urology, Hopital Erasme, Université Libre de Bruxelles, Belgium
| | - Grégoire Assenmacher
- 2 Department of Urology, Institut Jules Bordet, Université Libre de Bruxelles, Belgium
| | - Alexandre Peltier
- 2 Department of Urology, Institut Jules Bordet, Université Libre de Bruxelles, Belgium
| | - Roland van Velthoven
- 2 Department of Urology, Institut Jules Bordet, Université Libre de Bruxelles, Belgium
| | - Thierry Roumeguère
- 1 Department of Urology, Hopital Erasme, Université Libre de Bruxelles, Belgium
| |
Collapse
|
26
|
Poelaert F, Joniau S, Roumeguère T, Ameye F, De Coster G, Dekuyper P, Quackels T, Van Cleynenbreugel B, Van Damme N, Van Eycken E, Mottrie A, Lumen N. Current Management of pT3b Prostate Cancer After Robot-assisted Laparoscopic Prostatectomy. Eur Urol Oncol 2019; 2:110-117. [DOI: 10.1016/j.euo.2018.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 04/30/2018] [Accepted: 05/08/2018] [Indexed: 01/18/2023]
|
27
|
Marcelis Q, Albisinni S, Van Velthoven R, Peltier A, Roumeguère T, Quackels T. Risque d’invasion ganglionnaire après prostatectomie radicale cœlioscopique robot-assistée : validation externe du nomogramme de Briganti. Prog Urol 2018. [DOI: 10.1016/j.purol.2018.07.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
28
|
Joosten A, Hafiane R, Pustetto M, Van Obbergh L, Quackels T, Buggenhout A, Vincent JL, Ickx B, Rinehart J. Practical impact of a decision support for goal-directed fluid therapy on protocol adherence: a clinical implementation study in patients undergoing major abdominal surgery. J Clin Monit Comput 2018; 33:15-24. [PMID: 29779129 DOI: 10.1007/s10877-018-0156-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 05/15/2018] [Indexed: 12/19/2022]
Abstract
The purpose of this study was to assess the effects of using a real time clinical decision-support system, "Assisted Fluid Management" (AFM), to guide goal-directed fluid therapy (GDFT) during major abdominal surgery. We compared a group of patients managed using the AFM system with a historical cohort of patients (control group) who had been managed using a manual GDFT strategy. Adherence to the protocol was defined as the relative intraoperative time spent with a stroke volume variation (SVV) < 13%. We hypothesised that patients in the AFM group would have more time during surgery with a SVV < 13% compared to the control group. All patients had a radial arterial line connected to a pulse contour analysis monitor and received a 2 ml/kg/h maintenance crystalloid infusion. Additional 250 ml crystalloid boluses were administered whenever measured SVV ≥ 13% in the control group, and when the software suggested a fluid bolus in the AFM group. We compared 46 AFM-guided patients to 38 controls. Patients in the AFM group spent significantly more time during surgery with a SVV < 13% compared to the control group (median 92% [82, 96] vs. 76% [54, 86]; P < 0.0005), and received less fluid overall (1775 ml [1225, 2425] vs. 2350 ml [1825, 3250]; P = 0.010). The incidence of postoperative complications was comparable in the two groups. Implementation of a decision support system for GDFT guidance resulted in a significantly longer period during surgery with a SVV < 13% with a reduced total amount of fluid administered. Trial registration: Clinical Trials.gov (NCT03141411).
Collapse
Affiliation(s)
- Alexandre Joosten
- Department of Anesthesiology, CUB Erasme, Hopital ERASME, Université Libre de Bruxelles, 808, route de Lennik, 1070, Brussels, Belgium.
| | - Reda Hafiane
- Department of Anesthesiology, CUB Erasme, Hopital ERASME, Université Libre de Bruxelles, 808, route de Lennik, 1070, Brussels, Belgium
| | - Marco Pustetto
- Department of Anesthesiology, CUB Erasme, Hopital ERASME, Université Libre de Bruxelles, 808, route de Lennik, 1070, Brussels, Belgium
| | - Luc Van Obbergh
- Department of Anesthesiology, CUB Erasme, Hopital ERASME, Université Libre de Bruxelles, 808, route de Lennik, 1070, Brussels, Belgium
| | - Thierry Quackels
- Department of Urology, CUB Erasme, Université Libre de Bruxelles, 808, route de Lennik, 1070, Brussels, Belgium
| | - Alexis Buggenhout
- Department of Colorectal Surgery, CUB Erasme, Université Libre de Bruxelles, 808, route de Lennik, 1070, Brussels, Belgium
| | - Jean-Louis Vincent
- Department of Intensive Care, CUB Erasme, Université Libre de Bruxelles, 808, route de Lennik, 1070, Brussels, Belgium
| | - Brigitte Ickx
- Department of Anesthesiology, CUB Erasme, Hopital ERASME, Université Libre de Bruxelles, 808, route de Lennik, 1070, Brussels, Belgium
| | - Joseph Rinehart
- Department of Anesthesiology & Perioperative Care, University of California Irvine, 101 the City Drive South, Orange, CA, USA
| |
Collapse
|
29
|
Albisinni S, Aoun F, Marcelis Q, Idrissi M, Quackels T, Limani K, Hawaux E, Peltier A, van Velthoven R, Roumeguère T. PD29-10 VALIDATED ASSESSMENT OF URINARY, SEXUAL AND GASTROINTESTINAL QUALITY OF LIFE AFTER ROBOTIC ASSISTED LAPAROSCOPIC PROSTATECTOMY: BEYOND CONTINENCE AND ERECTIONS. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
30
|
Holz S, Albisinni S, Gilsoul J, Pirson M, Duthie V, Quackels T, Vanden Bossche M, Roumeguère T. Risk factor assessment in high-risk, bacillus Calmette-Guérin-treated, non-muscle-invasive bladder cancer. Res Rep Urol 2017; 9:195-202. [PMID: 29034222 PMCID: PMC5628686 DOI: 10.2147/rru.s143865] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objective To assess the risk factors associated with recurrence, progression and survival in high-risk non-muscle-invasive bladder cancer (NMIBC) patients treated with bacillus Calmette–Guérin (BCG) and validate the European Organization for Research and Treatment of Cancer (EORTC) and Spanish Urological Club for Oncological Treatment (CUETO) scores. Patients and methods We retrospectively analyzed all BCG-treated NMIBC patients from 1998 to 2012. Multiple variables were tested as risk factors for recurrence-free survival and progression-free survival (PFS). Variables included age, sex, grade, stage, tumor size, number of tumors, carcinoma in situ (CIS), recurrence status, BCG strain used, smoking status, use of re-staging transurethral resection and use of single immediate postoperative instillation. We also tested the accuracy of EORTC and CUETO scores in predicting recurrence and progression. Results Overall, 123 patients were analyzed. Median (interquartile range) follow-up was 49 months. The 5-year overall survival, cancer-specific survival, recurrence-free survival and PFS were 75.0%, 89.3%, 59.4% and 79.2%, respectively. On univariate analysis, multiple tumors (≥3), concomitant CIS and smoking influenced recurrence. Regarding progression, multiple tumors, concomitant CIS and Connaught strain (vs Tice) negatively influenced PFS on univariate and multivariate analyses were independent prognostic factors. CUETO scores were accurate, with a slight overestimation, while EORTC score was not predictive of recurrence or progression. Conclusion In this study, CIS and tumor multiplicity were unfavorable predictors of recurrence and progression in patients with NMIBC receiving BCG. CUETO model was superior to EORTC risk tables in predicting recurrence and progression in our BCG-treated patient population. Nonetheless, both scores overestimated recurrence and progression rates. Prospective trials are needed to validate our findings.
Collapse
Affiliation(s)
- Serge Holz
- Department of Urology, Erasme Hospital, Université libre de Bruxelles, Belgium
| | - Simone Albisinni
- Department of Urology, Erasme Hospital, Université libre de Bruxelles, Belgium
| | - Jacques Gilsoul
- Department of Urology, Erasme Hospital, Université libre de Bruxelles, Belgium
| | - Michel Pirson
- Department of Urology, Erasme Hospital, Université libre de Bruxelles, Belgium
| | - Véronique Duthie
- Department of Urology, Erasme Hospital, Université libre de Bruxelles, Belgium
| | - Thierry Quackels
- Department of Urology, Erasme Hospital, Université libre de Bruxelles, Belgium
| | - Marc Vanden Bossche
- Department of Urology, Erasme Hospital, Université libre de Bruxelles, Belgium
| | - Thierry Roumeguère
- Department of Urology, Erasme Hospital, Université libre de Bruxelles, Belgium
| |
Collapse
|
31
|
Albisinni S, Joniau S, Quackels T, De Coster G, Dekuyper P, Van Cleynenbreugel B, Van Damme N, Van Eycken E, Ameye F, Roumeguère T. Current trends in patient enrollment for robotic-assisted laparoscopic prostatectomy in Belgium. Cancer 2017; 123:4139-4146. [DOI: 10.1002/cncr.30874] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 04/25/2017] [Accepted: 06/12/2017] [Indexed: 12/31/2022]
Affiliation(s)
- Simone Albisinni
- Department of Urology; University Clinics of Brussels, Erasmus Hospital, Free University of Brussels; Brussels Belgium
| | - Steven Joniau
- Department of Urology; University Hospitals Leuven; Leuven Belgium
| | - Thierry Quackels
- Department of Urology; University Clinics of Brussels, Erasmus Hospital, Free University of Brussels; Brussels Belgium
| | | | - Peter Dekuyper
- Department of Urology; Maria Middelares General Hospital; Ghent Belgium
| | | | | | | | - Filip Ameye
- Department of Urology; Maria Middelares General Hospital; Ghent Belgium
| | - Thierry Roumeguère
- Department of Urology; University Clinics of Brussels, Erasmus Hospital, Free University of Brussels; Brussels Belgium
| | | |
Collapse
|
32
|
Castells X, Ardin M, Rorive S, Broeders N, Song Y, Villar S, Carreira C, Bringuier PP, Heguy A, Quackels T, Roumeguere T, Nortier J, Zavadil J. Abstract 5738: Tracking the genetic relationship between first and late-onset second urothelial cancers by mutational signature analysis. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-5738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Exposure to aristolochic acid (AA, IARC Group 1 carcinogen) present in some traditional herbal medicines leads to aristolochic acid nephropathy (AAN), often complicated by development of multiple urothelial carcinomas of sequential onset. We used genome-scale mutational signature analysis of multiple urinary tract tumors of AAN cases from a unique patient group to determine the relationships of the patients’ late-onset second cancers to the AA exposure as well as to the first cancers.
Aristolactam-DNA adduct-positive AAN patients (n=4) who developed cancer within 8 years following the initial exposure to AA were chosen for analysis of their first cancers (upper tract urothelial carcinomas, UTUC) and second cancers of delayed onset (1-9 years after first-cancer diagnosis, involving the bladder or ureteral meatus). All patients had received a kidney transplant before developing the second cancers and had a functional renal graft prior to prophylactic nephroureterectomy. Genomic DNAs were isolated from FFPE sections of the renal cortex and from the upper and lower tract tumors of each patient using laser capture micro-dissection or macro-dissection of the tumor areas. Low-coverage (~15x) exome 100-bp paired-end sequencing was performed using Illumina HiSeq2500. Customized variant calling identified somatic variants absent in non-tumor tissues. Non-negative matrix factorization was applied to extract mutational signatures in the tumor tissues.
In all cases, we established the mutational signature of AA (the COSMIC signature 22) in the first UTUC as well as second cancers involving the bladder or lower ureter (meatus). Additionally, the first and second cancers harbored considerable overlaps in exposure-specific (A>T) somatic mutations. This finding provides evidence that the delayed onset of bladder urothelial carcinomas in AAN patients is likely due to distal seeding of cancer cells originating from the primary UTUC tumors.
Our first-of-its-kind study addresses the risk as well as mechanistic factors leading to the second, late-onset bladder urothelial carcinomas following kidney transplantation and primary UTUC development. Our results underline the importance of long-term bladder follow-up in high-risk populations with established or suspected AA exposure.
Funding: IARC; NYU Genome Technology Center is partially supported by the NIH/NCI (P30CA016087) grant.
Citation Format: Xavier Castells, Maude Ardin, Sandrine Rorive, Nilufer Broeders, Yan Song, Stephanie Villar, Christine Carreira, Pierre-Paul Bringuier, Adriana Heguy, Thierry Quackels, Thierry Roumeguere, Joelle Nortier, Jiri Zavadil. Tracking the genetic relationship between first and late-onset second urothelial cancers by mutational signature analysis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5738. doi:10.1158/1538-7445.AM2017-5738
Collapse
Affiliation(s)
| | - Maude Ardin
- 1International Agency for Research on Cancer, Lyon, France
| | - Sandrine Rorive
- 2Pathology, Université Libre de Bruxelles, Erasme University Hospital, Brussels, Belgium
| | - Nilufer Broeders
- 3Nephrology, Université Libre de Bruxelles, Erasme University Hospital, Brussels, Belgium
| | - Yan Song
- 4Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | | | | | | | - Adriana Heguy
- 6New York University Langone Medical Center, New York, NY
| | - Thierry Quackels
- 7Urology, Université Libre de Bruxelles, Erasme University Hospital, Brussels, Belgium
| | - Thierry Roumeguere
- 7Urology, Université Libre de Bruxelles, Erasme University Hospital, Brussels, Belgium
| | - Joelle Nortier
- 3Nephrology, Université Libre de Bruxelles, Erasme University Hospital, Brussels, Belgium
| | - Jiri Zavadil
- 1International Agency for Research on Cancer, Lyon, France
| |
Collapse
|
33
|
Albisinni S, Grosman J, Aoun F, Quackels T, Peltier A, van Velthoven R, Roumeguére T. MP93-13 EXPLORING POSITIVE SURGICAL MARGINS AFTER MINIMALLY INVASIVE RADICAL PROSTATECTOMY: DOES BODY HABITUS REALLY MAKE A DIFFERENCE? J Urol 2017. [DOI: 10.1016/j.juro.2017.02.2895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
34
|
Moyson J, Legrand F, Vanden Bossche M, Quackels T, Roumeguère T. [Efficacy and safety of available therapies in the management of idiopathic overactive bladder: A systematic review of the literature]. Prog Urol 2017; 27:203-228. [PMID: 28228331 DOI: 10.1016/j.purol.2016.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 12/26/2016] [Accepted: 12/29/2016] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Study the efficacy and adverse events of different pharmacological lines in the treatment of idiopathic overactive bladder (iOAB). METHODS PubMed research on meta-analyses and randomized controlled trials (RCT) focused on the efficacy and adverse effects of anticholinergics, botulinum toxin and mirabegron since 2005. RESULTS Ten meta-analyses of anticholinergics were selected; 16 randomized controlled trials (ERC) comparing botulinum toxin A to either anticholinergic or placebo and 10 ERC studying mirabegron. All the molecules studied showed efficacy compared to placebo in the treatment of iOAB. Anticholinergics remain the first-line pharmacological treatment allowing a significant reduction in the number (nb) of incontinence (-5/week) and in the number of urination (-4/week) as well as a perception of subjective improvement of the symptoms reported by 56 % of the patients treated against 41 % for the placebo group (RR: 1.39 [95 % CI: 1.28-1.51]). The most commonly reported side effect is dry mouth (30 % vs. 8 % in the placebo group). Injections of botulinum toxin A appear to be relatively comparable to anticholinergics in the first line with a decrease in urinary emergency incontinence (UTI) of 3.3/d in the toxin group versus 3.4/d in the anticholinergic group (P=0.81). There was also a higher rate of complete resolution of urinary incontinence in the toxin group (27 % vs. 13 % P=0.03) but significant adverse effects such as lower urinary tract infections (33 % vs. 13 % P>0.01). And the risk of using self-catheterization (5 % vs. 0 % P=0.01). In view of the invasive character of the toxin injections and their side effects, this treatment remains a 2nd line therapy. The same is true for mirabegron: similar efficacy (IUU number in the mirabegron group 50mg -1.74 vs. -1.53 In the solifenacin group 5mg, P>0.5) but different side effects with arterial hypertension (the oral dryness rate being comparable to that in the placebo group). The choice of use of anticholinergic or mirabegron should be based on the balance of efficacy/tolerance to be estimated for each patient. CONCLUSION The different molecules have shown their efficacy in the treatment of iOAB with acceptable tolerance. There is a lack of direct comparisons between treatments available. Further studies are needed to evaluate the possible interest of a combination of these molecules as well as the search for predictive factors of response to these different therapies.
Collapse
Affiliation(s)
- J Moyson
- Hôpital universitaire Erasme ULB, 808, route de Lennik, 1070 Bruxelles, Belgique.
| | - F Legrand
- Hôpital universitaire Erasme ULB, 808, route de Lennik, 1070 Bruxelles, Belgique
| | - M Vanden Bossche
- Hôpital universitaire Erasme ULB, 808, route de Lennik, 1070 Bruxelles, Belgique
| | - T Quackels
- Hôpital universitaire Erasme ULB, 808, route de Lennik, 1070 Bruxelles, Belgique
| | - T Roumeguère
- Hôpital universitaire Erasme ULB, 808, route de Lennik, 1070 Bruxelles, Belgique
| |
Collapse
|
35
|
Castells X, Ardin M, Rorive S, Broeders N, Heguy A, Bringuier P, Quackels T, Roumeguere T, Nortier J, Zavadil J. Genome-wide sequencing identifies genetic relationship between first and late-onset second cancers in aristolochic acid nephropathy patients. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)61121-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
36
|
Tosco L, Ameye F, Albisinni S, Dekuyper P, Jegou D, Quackels T, Roumeguere T, Van Cleynenbreugel B, Van Damme N, Van Eycken L, Joniau S. MP9-20 BASELINE CLINICAL CARACHTERISTICS AND PATHOLOGICAL OUTCOMES FOLLOWING ROBOTIC-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY (RALP): A POPULATION BASED PROSPECTIVE SERIES. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
37
|
Roumeguère T, Broeders N, Jayaswal A, Rorive S, Quackels T, Pozdzik A, Arlt VM, Schmeiser HH, Nortier JL. Bacillus Calmette-Guerin therapy in non-muscle-invasive bladder carcinoma after renal transplantation for end-stage aristolochic acid nephropathy. Transpl Int 2015; 28:199-205. [PMID: 25377421 DOI: 10.1111/tri.12484] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 08/27/2014] [Accepted: 11/03/2014] [Indexed: 11/29/2022]
Abstract
Intravesical instillation of bacillus Calmette-Guerin (BCG) is the treatment of choice for non-muscle-invasive bladder cancer (NMIBC) of high grade and/or carcinoma in situ. This study evaluated the feasibility, efficacy, and tolerance of BCG instillations in eight kidney recipients for end-stage aristolochic acid nephropathy (AAN), a condition at high risk of urothelial carcinoma, and diagnosed for NMIBC. Five of them had relapsed after mitomycin C treatment. Tolerance to BCG was evaluated clinically and regular follow-up with fluorescence cystoscopy was performed along with renal graft function monitoring. Immunosuppression doses were adjusted and prophylactic anti-tuberculous treatment given to reduce risks of graft rejection and infection. After a mean follow-up period of 50 months, seven of the eight patients are free of relapse and kidney graft function remained unchanged. Tolerance was good, except for one episode of fever and one early discontinuation because of subjective discomfort. No systemic tuberculous infection was observed. This is the first clinical observation of successful BCG therapy for NMIBC in patients given transplant for end-stage AAN. Under standardized conditions, immunotherapy based on intravesical BCG is feasible, effective, and well tolerated in renal transplantation.
Collapse
Affiliation(s)
- Thierry Roumeguère
- Department of Urology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Holz S, Moyson J, Henriet B, Idrissi-Kaitouni M, Quackels T, Van den Bosche M, Roumeguère T. [Acute renal failure following rectosigmoidoscopy]. Prog Urol 2013; 23:219-21. [PMID: 23446287 DOI: 10.1016/j.purol.2012.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 10/24/2012] [Accepted: 10/25/2012] [Indexed: 11/30/2022]
Abstract
We report the case of a 24-year old man with a past history of vesical extrophy and ureterosigmoidostomy in childhood, admitted with acute left flank pain and acute renal failure. The complaints started the day following the endoscopic resection of a sigmoid polyp. The stricture of the ureterosigmoid junction was diagnosed by intravenous urography. Conservative treatment with endo-ureteral dilatation was successfully performed. At 2 years of follow-up, the patient is still asymptomatic, without any residual hydronephrosis.
Collapse
Affiliation(s)
- S Holz
- Service d'urologie, hôpital Erasme-ULB, cliniques universitaires de Bruxelles, 808, route de Lennik, 1070 Bruxelles, Belgique.
| | | | | | | | | | | | | |
Collapse
|
39
|
Jayaswal A, Roumeguere T, Broeders N, Quackels T, Rorive S, Lemy A, Nortier J. Tolérance et efficacité du BCG endovésical dans le traitement des cancers non musculoinvasifs de la vessie après transplantation rénale. Nephrol Ther 2011. [DOI: 10.1016/j.nephro.2011.07.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
40
|
Bollens R, Rosenblatt A, Espinoza BP, De Groote A, Quackels T, Roumeguere T, Vanden Bossche M, Wespes E, Zlotta AR, Schulman CC. Laparoscopic Partial Nephrectomy with “On-Demand” Clamping Reduces Warm Ischemia Time. Eur Urol 2007; 52:804-09. [PMID: 17482755 DOI: 10.1016/j.eururo.2007.04.011] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2006] [Accepted: 04/04/2007] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To investigate the impact of "on-demand" clamping during laparoscopic partial nephrectomy on warm ischemia time. METHODS We retrospectively reviewed 39 consecutive patients with renal tumors who had undergone transperitoneal laparoscopic partial nephrectomy from April 2002 to May 2006. Median tumor size was 2.3 cm. In all cases, the hilum was dissected early and extracorporeal clamping performed. The pedicle was clamped only in case of excessive bleeding, and it was released immediately after the closure of the renal defect with knot-tying sutures over Surgicel bolsters. RESULTS Median operative time was 120 min. Renal clamping was required in 31 of 39 patients and in this subgroup the median warm ischemia time was 9 min. Median operative blood loss was 150 ml. Eight patients required blood transfusion and among these two were converted to open surgery. Positive surgical margin was observed in one case. Renal cell carcinoma was present in 22 (54.4%) specimens. No recurrence was observed after a median follow-up of 15 mo. CONCLUSIONS This novel technique using extracorporeal clamping significantly decreases warm ischemia time, avoiding clamping of the pedicle in selected cases. Our study underlines the feasibility of performing laparoscopic partial nephrectomy with extracorporeal hilar clamping, allowing the shortest ischemia time ever published.
Collapse
Affiliation(s)
- Renaud Bollens
- Department of Urology, Erasme Hospital, University Clinics, Brussels, Belgium.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Abstract
PURPOSE OF REVIEW Laparoscopic radical prostatectomy is now an accepted treatment option for the management of localized prostate cancer. Numerous studies have demonstrated the feasibility and the reproducibility of this procedure. Expert teams in high-volume centres routinely carry out laparoscopic radical prostatectomy but for the novice the obstacle to success is how to learn and gain proficiency in this procedure. In this review, we will present our views on how this can be done. RECENT FINDINGS A learning curve includes the necessity for continuous self-evaluation in terms of cancer control, continence and potency. Many different methods can be used to acquire the technique: dry lab, animal live lab, cadaveric laparoscopic dissection or mentoring with an expert. All of these steps may not be essential as laparoscopic radical prostatectomy is not too dissimilar to open prostatectomy. However, one must understand that the physiological consequences of anaesthesia during laparoscopy and basic laparoscopic suturing technique should be perfected prior to taking on laparoscopic radical prostatectomy. The training then must continue under the supervision of a mentor. The opportunity for discussion with an expert allows the novice to learn the pitfalls and the tips and tricks of laparoscopic radical prostatectomy, thus reducing the length of the learning curve and negating the need to reinvent the wheel. SUMMARY Laparoscopic radical prostatectomy is similar to any other new surgical procedure and as with open surgery we learn and gain experience with each procedure; the learning curve is never completely finished.
Collapse
Affiliation(s)
- Renaud Bollens
- Clinics University of Brussels, Department of Urology, Erasme Hospital, 808 route de Lennik, B-1070 Brussels, Belgium.
| | | | | | | | | |
Collapse
|
42
|
Ho KM, Bollens R, Quackels T, Roumeguere T, Schulman CC. A simple maneuver to replace dislodged laparoscopic port. Urology 2004; 64:799-801. [PMID: 15491726 DOI: 10.1016/j.urology.2004.04.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2004] [Accepted: 04/28/2004] [Indexed: 11/28/2022]
Abstract
Inadvertent dislodgment of laparoscopic port can occur despite preventive measures. We describe a simple maneuver to replace a dislodged port using a palpation probe. The principle is analogous to that of using a laparoscopic grasping forceps. It is easy to perform, quick, reliable, safe, and particularly useful for the laparoscopists in training.
Collapse
Affiliation(s)
- K M Ho
- Department of Urology, Erasme Hospital, Brussels, Belgium
| | | | | | | | | |
Collapse
|
43
|
Roumeguere T, Bollens R, Vanden Bossche M, Rochet D, Bialek D, Hoffman P, Quackels T, Damoun A, Wespes E, Schulman CC, Zlotta AR. Radical prostatectomy: a prospective comparison of oncological and functional results between open and laparoscopic approaches. World J Urol 2003; 20:360-6. [PMID: 12682770 DOI: 10.1007/s00345-002-0306-z] [Citation(s) in RCA: 118] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2002] [Accepted: 11/15/2002] [Indexed: 10/25/2022] Open
Abstract
We prospectively compared, within the same center and during the same period of time, the perioperative parameters as well as the oncological and functional results of both open retropubic (ORP) and laparoscopic radical prostatectomy (LRP). From September 1999 to September 2001, 162 patients with prostate cancer were treated with radical prostatectomy, 77 using an open retropubic technique, and 85 by the laparoscopic extraperitoneal approach. We prospectively recorded pre-, per- and postoperative parameters and complications, and evaluated the carcinological and functional results, comparing both approaches. There were no significant differences in the preoperative characteristics of the two groups. Mean operative time was statistically longer with LRP than with ORP (288 vs 168 min, P<0.0001) but median blood loss was decreased (400 vs 1,300 ml, P<0.0001). Major complications occurred in a similar number of cases (5% vs 2.4%, NS) while minor complications occurred more frequently with ORP (24.6 vs 11.8%, P=0.003). Pathological examination revealed a similar distribution of Gleason scores and stages in each group. Positive surgical margins in pT2 cases occurred in 7.8% of LRP and 7.3% of ORP. Continence rates (no pad and no leakage at all) were similar (83.9% in ORP vs 80.7% in LRP, NS). Potency rates were similar after 1 year in patients undergoing bilateral nerve sparing (55% in ORP vs 65% in LRP, NS). However, patients operated by LRP had more spontaneous erections. We conclude that this prospective, comparative study shows that LRP, when performed in specialized centers, gives oncological and functional results comparable to open surgery.
Collapse
Affiliation(s)
- Thierry Roumeguere
- Department of Urology, Erasme Hospital--University Clinics of Brussels, 808 route de Lennik, 1070 Brussels, Belgium.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Bollens R, Roumeguere T, Quackels T. [Comprehensive laparoscopic approach in female prolapsus]. Rev Med Brux 2002; 23:A180-1. [PMID: 12143159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Affiliation(s)
- R Bollens
- Service d'Urologie, Hôpital Erasme, U.L.B
| | | | | |
Collapse
|
45
|
Abstract
Over the past years, laparoscopic radical prostatectomy has emerged as an attractive, exciting, and new approach for the surgical treatment of localized prostate cancer. Several centers in Europe and the United States have developed their own technique and have already published their first results. Two main routes have been used, namely, the transperitoneal and extraperitoneal approaches. Data from the literature and available experience demonstrate that this laparoscopic procedure is feasible and teachable and that oncologic and functional results seem comparable to those of classic open radical prostatectomy. Minimal bleeding, reduced blood transfusion rates, shorter hospitalization, and shorter recovery time are unquestionable advantages for laparoscopic procedures. Laparoscopic radical prostatectomy remains a difficult intervention and should be performed in selected centers with experienced teams who already have extensive laparoscopic experience and who recruit enough patients to grant them the proper amount of expertise. This is the only way to achieve excellence in terms of oncologic and functional results.
Collapse
Affiliation(s)
- Renaud Bollens
- Department of Urology, Hôpital Erasme, Route de Lennik 808, 1070 Brussels, Belgium.
| | | | | | | | | | | |
Collapse
|