Uro-Oncology in the Robotic Era: Advancements, Limitations, and Further Perspectives

Topic Information

Dear Colleagues, 

In recent decades, we have witnessed a growing interest in the application of robotic surgical platforms in the field of uro-oncology. This has brought shorter operation and recovery times, reduced pain, and superior cosmetic outcomes. Since their earliest application, robots have revolutionized the treatment of uro-genital malignances and, nowadays, most radical prostatectomies and radical/partial nephrectomies are performed using a robot-assisted approach. Robotics is progressively becoming the standard of care also for the treatment of urothelial carcinomas (although results of recent randomized-controlled trials comparing robot-assisted and open surgery reported conflicting results) and the path towards the application of minimally invasive approaches to penile cancer treatment has been paved. This Topic aims to offer a comprehensive overview of recent applications, advances, challenges and future perspectives concerning robotic uro-oncology. We invite manuscripts that contain both theoretical and practical/experimental results. Potential topics include but are not limited to the following: robotic prostatectomy, robotic partial nephrectomy, robotic cystectomy, robotic nephroureterectomy, robotic adrenalectomy, robotic inguinal lymphadenectomy for penile cancer, and robotic approaches to complications resulting from uro-oncologic treatments.

Prof. Dr. Cosimo De Nunzio
Dr. Aldo Brassetti
Topic Editors

Keywords

Participating Journals

Journal Name	Impact Factor	CiteScore	Launched Year	First Decision (median)	APC
AI ai	3.1	7.2	2020	18.9 Days	CHF 1600
BioMedInformatics biomedinformatics	-	1.7	2021	22 Days	CHF 1000
Cancers cancers	4.5	8.0	2009	17.4 Days	CHF 2900
Current Oncology curroncol	2.8	3.3	1994	19.8 Days	CHF 2200
Medical Sciences medsci	-	-	2013	24 Days	CHF 1400

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Published Papers (3 papers)

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All AI BioMedInformatics Cancers Current Oncology Medical Sciences

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13 pages, 1111 KiB  

Open AccessArticle

The Association of Ischemia Type and Duration with Acute Kidney Injury after Robot-Assisted Partial Nephrectomy

by Fabian Obrecht, Christian Padevit, Gabriel Froelicher, Simon Rauch, Marco Randazzo, Shahrokh F. Shariat, Hubert John and Beat Foerster

Curr. Oncol. 2023, 30(11), 9634-9646; https://doi.org/10.3390/curroncol30110698 - 31 Oct 2023

Viewed by 1808

Abstract

Background: Acute kidney injury (AKI) after robot-assisted partial nephrectomy (RAPN) is a robust surrogate for chronic kidney disease. The objective of this study was to evaluate the association of ischemia type and duration during RAPN with postoperative AKI. Materials and methods: We reviewed [...] Read more.

Background: Acute kidney injury (AKI) after robot-assisted partial nephrectomy (RAPN) is a robust surrogate for chronic kidney disease. The objective of this study was to evaluate the association of ischemia type and duration during RAPN with postoperative AKI. Materials and methods: We reviewed all patients who underwent RAPN at our institution since 2011. The ischemia types were warm ischemia (WI), selective artery clamping (SAC), and zero ischemia (ZI). AKI was defined according to the Risk Injury Failure Loss End-Stage (RIFLE) criteria. We calculated ischemia time thresholds for WI and SAC using the Youden and Liu indices. Logistic regression and decision curve analyses were assessed to examine the association with AKI. Results: Overall, 154 patients met the inclusion criteria. Among all RAPNs, 90 (58.4%), 43 (28.0%), and 21 (13.6%) were performed with WI, SAC, and ZI, respectively. Thirty-three (21.4%) patients experienced postoperative AKI. We extrapolated ischemia time thresholds of 17 min for WI and 29 min for SAC associated with the occurrence of postoperative AKI. Multivariable logistic regression analyses revealed that WIT ≤ 17 min (odds ratio [OR] 0.1, p < 0.001), SAC ≤ 29 min (OR 0.12, p = 0.002), and ZI (OR 0.1, p = 0.035) significantly reduced the risk of postoperative AKI. Conclusions: Our results confirm the commonly accepted 20 min threshold for WI time, suggest less than 30 min ischemia time when using SAC, and support a ZI approach if safely performable to reduce the risk of postoperative AKI. Selecting an appropriate ischemia type for patients undergoing RAPN can improve short- and long-term functional kidney outcomes. Full article

(This article belongs to the Topic Uro-Oncology in the Robotic Era: Advancements, Limitations, and Further Perspectives)

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10 pages, 598 KiB  

Open AccessArticle

Comparing Robotic-Assisted to Open Radical Cystectomy in the Management of Non-Muscle-Invasive Bladder Cancer: A Propensity Score Matched-Pair Analysis

by Etienne Courboin, Romain Mathieu, Valentina Panetta, Georges Mjaess, Romain Diamand, Gregory Verhoest, Mathieu Roumiguié, Anne Sophie Bajeot, Francesco Soria, Chiara Lonati, Claudio Simeone, Giuseppe Simone, Umberto Anceschi, Paolo Umari, Ashwin Sridhar, John Kelly, Laura S. Mertens, Rafael Sanchez-Salas, Anna Colomer, Maria Angela Cerruto, Alessandro Antonelli, Wojciech Krajewski, Thierry Quackels, Alexandre Peltier, Francesco Montorsi, Alberto Briganti, Jeremy Y. C. Teoh, Benjamin Pradere, Marco Moschini, Thierry Roumeguère and Simone Albisinniadd Show full author list remove Hide full author list

Cancers 2023, 15(19), 4732; https://doi.org/10.3390/cancers15194732 - 26 Sep 2023

Viewed by 1415

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 [...] Read more.

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. Full article

(This article belongs to the Topic Uro-Oncology in the Robotic Era: Advancements, Limitations, and Further Perspectives)

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10 pages, 463 KiB  

Open AccessArticle

Urinary Continence Recovery after Retzius-Sparing Robot Assisted Radical Prostatectomy and Adjuvant Radiation Therapy

by Alberto Olivero, Stefano Tappero, Ofir Maltzman, Enrico Vecchio, Giorgia Granelli, Silvia Secco, Alberto Caviglia, Aldo Massimo Bocciardi, Antonio Galfano and Paolo Dell’Oglio

Cancers 2023, 15(17), 4390; https://doi.org/10.3390/cancers15174390 - 1 Sep 2023

Cited by 2 | Viewed by 1643

Abstract

Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) allows the preservation of the structures advocated to play a crucial role in the continence mechanism. This study aims to evaluate the association between adjuvant radiation therapy (aRT) and urinary continence (UC) recovery after RS-RARP. For the purpose [...] Read more.

Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) allows the preservation of the structures advocated to play a crucial role in the continence mechanism. This study aims to evaluate the association between adjuvant radiation therapy (aRT) and urinary continence (UC) recovery after RS-RARP. For the purpose of the current study, all patients submitted to RS-RARP for prostate cancer (PCa) at a single high-volume European institution between January 2010 and December 2021 were identified. Only patients that harbored pT2 stage with positive surgical margins or pT3/pN1 stage with or without positive surgical margins were included in the analyses. Two groups of patients were identified as follows: patients who had undergone aRT and patients submitted to observation (no-aRT patients). As per definition, aRT was delivered within 1–6 months after surgery. After 1:1 propensity score matching, 124 aRT patients were compared with 124 no-aRT patients who continued standard follow-up protocol after surgery. UC recovery was 81 vs. 84% in aRT vs. no-aRT patients (p = 0.7). In multivariable Cox regression analyses, aRT did not reach the independent predictor status for UC recovery at 12 months. In the subgroup analysis including only aRT patients, only the nerve-sparing technique was independently associated with UC recovery at 12 months. Conversely, the type of aRT (IMRT/VMAT vs. 3D-CRT) did not reach the independent predictor status for UC recovery at 12 months. The current study is the first to address the association between aRT and UC recovery in patients treated with RS-RARP for PCa. Based on our data, aRT is not associated with worse UC recovery. In the cohort of patients treated with aRT, the nerve-sparing technique independently predicted UC recovery. Full article

(This article belongs to the Topic Uro-Oncology in the Robotic Era: Advancements, Limitations, and Further Perspectives)

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