Minimally Invasive Management of Urologic Oncology

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Nephrology & Urology".

Deadline for manuscript submissions: closed (30 March 2024) | Viewed by 2498

Special Issue Editor


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Guest Editor
1. Departamento de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
2. Department of Medicine, Surgery and Pharmacy, Universitá degli Studi di Sassari, Sassari, Italy
Interests: endourology; prostate cancer; kidney cancer; urothelial cancer; penile cancer; laparoscopic and robotic urological surgery; minimally invasive surgery; targeted therapy

Special Issue Information

Dear Colleagues,

The management of urological cancers has dramatically changed in the last 20 years; with the introduction of several technological innovations and the refinement of minimally invasive techniques, surgical oncologic treatment algorithms have become more and more complex.

In fact, the role of major oncologic surgery, in most cases considered the gold standard for the treatment of localised urological neoplasms, has lately been downsized, with new organ-sparing options being recommended as the first-line treatment by international guidelines.

For example, radical nephroureterectomy has been traditionally considered the gold standard for the treatment of localised upper-tract urothelial cancer; with the advent of flexible ureteroscopy and new laser generators, low-risk UTUC is nowadays considered, as part of an endoscopic nephron-sparing approach.

The evolution of imaging has also had a crucial role in enhancing targeted and minimally invasive treatments, such as multiparametric MRI allowing for focal ablation of prostate cancer lesions; focal treatment indications have also been expanding for small renal masses.

The refinement of robotic surgery has contributed to the lower morbidity of major surgery, such as the spread of robotic-assisted radical cystectomy with intracorporeal urine diversion.

Finally, minimally invasive management is focused on reducing the risk of major salvage surgery: this is the case for glycosamineglycans replacement instillations, the effect of which in reducing the risk of radiation cystitis progression and salvage cystectomy has been shown in increasing numbers of recent studies.

In this Special Issue of JCM, we aim to publish up-to-date reports on the new challenges in uro-oncology under the motto of “less is more”.

Prof. Dr. Francesco Sanguedolce
Guest Editor

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Keywords

  • robotic surgery
  • laparoscopic surgery
  • endourology
  • prostate cancer
  • urothelial cancer
  • renal cancer
  • penile cancer
  • technology
  • minimally invasive surgery
  • ablative treatment
  • imaging
  • targeted therapy

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Published Papers (2 papers)

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Research

11 pages, 1287 KiB  
Article
Simultaneous Bilateral Video–Endoscopic Inguinal Lymphadenectomy for Penile Carcinoma: Surgical Setting, Feasibility, Safety, and Preliminary Oncological Outcomes
by Josep M. Gaya, Giuseppe Basile, Pavel Gavrilov, Andrea Gallioli, Angelo Territo, Jorge Robalino, Pedro Hernandez, Raul Sanchez-Molina, Alejandra Bravo, Ferran Algaba, Jordi Huguet, Francesco Sanguedolce, Joan Palou, Antonio Rosales and Alberto Breda
J. Clin. Med. 2023, 12(23), 7272; https://doi.org/10.3390/jcm12237272 - 23 Nov 2023
Viewed by 1160
Abstract
Introduction: Inguinal lymph node dissection (ILND) plays an important role for both staging and treatment purposes in patients diagnosed with penile carcinoma (PeCa). Video–endoscopic inguinal lymphadenectomy (VEIL) has been introduced to reduce complications, and in those patients elected for bilateral ILND, a simultaneous [...] Read more.
Introduction: Inguinal lymph node dissection (ILND) plays an important role for both staging and treatment purposes in patients diagnosed with penile carcinoma (PeCa). Video–endoscopic inguinal lymphadenectomy (VEIL) has been introduced to reduce complications, and in those patients elected for bilateral ILND, a simultaneous bilateral VEIL (sB-VEIL) has also been proposed. This study aimed to investigate the feasibility, safety, and preliminary oncological outcomes of sB-VEIL compared to consecutive bilateral VEIL (cB-VEIL). Material and methods: Clinical N0-2 patients diagnosed with PeCa and treated with cB-VEIL and sB-VEIL between 2015 and 2023 at our institution were included. Modified ILND was performed in cN0 patients, while cN+ patients underwent a radical approach. Intra- and postoperative complications, operative time, time of drainage maintenance, length of hospital stay and readmission within 90 days, as well as lymph node yield, were compared between the two groups. Results: Overall, 30 patients were submitted to B-VEIL. Of these, 20 and 10 patients underwent cB-VEIL and sB-VEIL, respectively. Overall, 16 (80%) and 7 (70%) patients were submitted to radical ILND due to cN1-2 disease in the cB-VEIL and sB-VEIL groups, respectively. No statistically significant difference emerged in terms of median nodal yield (13.5 vs. 14, p = 0.7) and median positive LNs (p = 0.9). sD-VEIL was associated with a shorter operative time (170 vs. 240 min, p < 0.01). No statistically significant difference emerged in terms of intraoperative estimated blood loss, length of hospital stay, time to drainage tube removal, major complications, and hospital readmission in the cB-VEIL and sB-VEIL groups, respectively (all p > 0.05). Conclusions: Simultaneous bilateral VEIL is a feasible and safe technique in patients with PeCA, showing similar oncological results and shorter operative time compared to a consecutive bilateral approach. Patients with higher preoperative comorbidity burden or anesthesiological risk are those who may benefit the most from this technique. Full article
(This article belongs to the Special Issue Minimally Invasive Management of Urologic Oncology)
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11 pages, 244 KiB  
Article
How May Longer Console Times Influence Outcomes after Robot-Assisted Radical Prostatectomy (RARP)?
by Mahmoud Farzat, Mohamed Elsherif and Florian M. Wagenlehner
J. Clin. Med. 2023, 12(12), 4022; https://doi.org/10.3390/jcm12124022 - 13 Jun 2023
Cited by 2 | Viewed by 948
Abstract
Longer operating time in radical prostatectomy may increase the risk of perioperative complications. Various factors such as cancer extent, the procedure’s level of difficulty, habitus and previous surgeries may lengthen robot-assisted radical prostatectomy (RARP) and therefore compromise outcomes. Objective: this study investigates the [...] Read more.
Longer operating time in radical prostatectomy may increase the risk of perioperative complications. Various factors such as cancer extent, the procedure’s level of difficulty, habitus and previous surgeries may lengthen robot-assisted radical prostatectomy (RARP) and therefore compromise outcomes. Objective: this study investigates the influence of operating time on outcomes after RARP in real life settings in a monocentric single surgeon study. Methods: a total of 500 sequential patients who were operated on between April 2019 and August 2022 were involved. Men were allocated to three groups short (n = 157; 31.4%), under or equal to 120 min; average (n = 255; 51%), between 121 and 180 min; long (n = 88; 17.6%), above 180 min console time. Demographic, baseline and perioperative data were analyzed and compared between groups. Univariate logistic regression was completed to investigate the association between console time and outcomes and to predict factors which may prolong surgery. Results: hospital stay and catheter days were significantly longer in group 3 with medians of 6 and 7 days (p < 0.001 and <0.001, respectively). Those findings were confirmed in univariate analysis, with p = 0.012 for catheter days and p < 0.001 for hospital stay. Moreover, major complications were higher in patients with longer procedures, at p = 0.008. Prostate volume was the only predictor of a prolonged console time (p = 0.005). Conclusion: RARP is a safe procedure and most patients will be discharged uneventfully. Yet, a longer console time is associated with a longer hospital stay, longer catheter days and major complications. Caution has to be taken in the large prostate to avoid longer procedures, which may prevent postoperative adverse events. Full article
(This article belongs to the Special Issue Minimally Invasive Management of Urologic Oncology)
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