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Medicina (Kaunas, Lithuania) Feb 2024: Our aim was to clarify the oncological outcomes of the two different approaches to laparoscopic nephroureterectomies (LNUs) in Japan, and to examine whether there were...
: Our aim was to clarify the oncological outcomes of the two different approaches to laparoscopic nephroureterectomies (LNUs) in Japan, and to examine whether there were any significant differences between the transperitoneal approach and the retroperitoneal approach. : We retrospectively evaluated patients who underwent an LNU for upper tract urothelial carcinoma (UTUC) from January 2013 to December 2022. We identified 52 patients who underwent a transperitoneal LNU (tLNU) and 93 who underwent a retroperitoneal LNU (rLNU). We adopted age, smoking, and pT-stage matching, and 43 patients were classified in each group. We investigated the time from surgery to recurrence (RFS: recurrence-free survival), the time to death (OS: overall survival), and the time to non-urothelial-tract recurrence-free survival (NUTRFS). A Cox regression analysis was performed to evaluate the risk factors that influenced recurrence. : There were no significant differences in the RFS, OS, and NUTRFS between the two matched groups. In the multivariate Cox regression analysis, the pT stage (pT3≥ vs. pT2≤) had an HR = 2.09 and a = 0.01, and was an independent prognostic risk factor regarding cancer recurrence. : There were no significant differences in the oncological outcomes between the tLNU and rLNU groups. It is suggested that the transperitoneal approach should be selected for LNUs.
Topics: Humans; Nephroureterectomy; Carcinoma, Transitional Cell; Treatment Outcome; Urinary Bladder Neoplasms; Retrospective Studies; Ureteral Neoplasms; Nephrectomy; Laparoscopy; Neoplasm Recurrence, Local
PubMed: 38541147
DOI: 10.3390/medicina60030421 -
Rare Tumors 2024The existence of both neuroendocrine and non-neuroendocrine histology in variable proportion in a lesion has been described by the World Health Organisation (WHO) as...
The existence of both neuroendocrine and non-neuroendocrine histology in variable proportion in a lesion has been described by the World Health Organisation (WHO) as mixed neuroendocrine and non-neuroendocrine neoplasm (MiNEN). The pathogenesis of this tumour remains controversial but molecular studies point towards a common monoclonal origin. Tumours are classified as functioning and nonfunctioning based on substances secreted. The nonfunctioning tumours may be discovered due to its local effect. Presented is a 66-year-old male with an intra-abdominal mass, underwent laparotomy and excision biopsy with transient right lower limb lymphoedema. Histology confirmed retroperitoneal MiNEN with no evidence of tumour recurrence 12 months following surgery. MiNENs should be considered as a differential diagnosis in patients with intra-abdominal mass. Surgical resection is recommended as this may offer the best treatment option.
PubMed: 38525086
DOI: 10.1177/20363613241242383 -
Cureus Feb 2024Hematopoiesis is an enormous and complex process. When the primary site of hematopoiesis fails to meet the requirements of the body in conditions like hemoglobinopathies...
Hematopoiesis is an enormous and complex process. When the primary site of hematopoiesis fails to meet the requirements of the body in conditions like hemoglobinopathies or myelofibrosis, various extramedullary sites take on the role of blood formation. Extramedullary hematopoiesis most commonly occurs in the liver, spleen, and lymph nodes and is rarely found in the thymus, heart, breast, adrenal glands, paravertebral regions, intraspinal tissue, and brain. Extramedullary hematopoiesis can mimic neoplasms in which symptoms are caused by the mass effect of the lesion. We report a rare case of a 41-year-old female patient with a fibrohematopoietic adrenal mass mimicking a neoplasm for which she underwent an adrenalectomy.
PubMed: 38523996
DOI: 10.7759/cureus.54598 -
Seminars in Radiation Oncology Apr 2024Surgical resection is the cornerstone of curative treatment for retroperitoneal sarcomas (RPS), aiming for complete excision, yet the complexity of RPS with its... (Review)
Review
Surgical resection is the cornerstone of curative treatment for retroperitoneal sarcomas (RPS), aiming for complete excision, yet the complexity of RPS with its proximity to vital structures continues to lead to high local recurrence rates after surgery alone. Thus, the role of radiotherapy (RT) continues to be refined to improve local control, which remains an important goal to prevent RPS recurrence. The recently completed global randomized trial to evaluate the role of surgery with and without preoperative RT - STRASS1, did not demonstrate a significant overall benefit for neoadjuvant RT based on the pre-specified definition of abdominal recurrence-free survival, however, sensitivity analysis using a standard definition of local recurrence and analysis of outcomes by compliance to the RT protocol suggests histology-specific benefit in well- and some de-differentiated liposarcomas. Ultimately, multidisciplinary collaboration and personalized approaches that consider histological sarcoma types and patient-specific factors are imperative for optimizing the therapeutic strategy in the management of RPS.
Topics: Humans; Sarcoma; Retroperitoneal Neoplasms; Combined Modality Therapy; Radiotherapy, Adjuvant; Neoadjuvant Therapy; Neoplasm Recurrence, Local
PubMed: 38508781
DOI: 10.1016/j.semradonc.2024.02.002 -
Frontiers in Endocrinology 2024The modified three-level technique for retroperitoneal laparoscopic adrenalectomy (RLA) has proven beneficial in the treatment of adrenal lesions in patients with...
OBJECTIVES
The modified three-level technique for retroperitoneal laparoscopic adrenalectomy (RLA) has proven beneficial in the treatment of adrenal lesions in patients with BMI≥25 Kg/m. This paper aims to summarize our institution's seven-year experience using this technique for all patients with Adrenal Lesions ≤ 6cm.
PATIENTS AND METHODS
Between January 2016 and December 2022. The patients underwent laparoscopic adrenal surgery were categorized into Zhang's technique (ZT) (Three-level Technique) group and modified technique (MT) group. The fundamental characteristics and perioperative data were analyzed, with statistical significance set at p<0.05.
RESULTS
In total, 731 patients were stratified into two groups: ZT (n=448) and MT (n=283). Statistically significant distinctions were not detected between the two groups regarding sex, BMI, tumor location, tumor size, tumor type, or American Society of Anesthesiologists (ASA) score (p>0.05). The MT group demonstrated superior outcomes compared to the ZT group in terms of operative time, estimated blood loss, drainage volume, diet recovery time, complication rates, and postoperative hospitalization duration (p<0.05). 17 (4.34%) in the ZT group required unplanned adrenalectomy, while there was none in MT group (P<0.05).
CONCLUSION
MT retroperitoneal laparoscopic adrenalectomy has demonstrated its benefits in the treatment of adrenal lesions across all patients with adrenal lesions ≤ 6cm, serving as a valuable point of reference for the surgical management of adrenal diseases.
PATIENT SUMMARY
We have made modifications to the classic retroperitoneal laparoscopic adrenalectomy and achieved superior surgical outcomes, resulting in a procedure known as modified retroperitoneal laparoscopic adrenalectomy. This technique is suitable for both obese individuals and the general population with adrenal lesions ≤ 6cm.
Topics: Humans; Retrospective Studies; Adrenal Gland Neoplasms; Adrenalectomy; Retroperitoneal Space; Laparoscopy
PubMed: 38501101
DOI: 10.3389/fendo.2024.1342240 -
Oncology Letters May 2024Retroperitoneal fibrosis, a rare and often idiopathic condition, poses significant diagnostic challenges. While most cases are considered idiopathic or immune-mediated,...
Retroperitoneal fibrosis, a rare and often idiopathic condition, poses significant diagnostic challenges. While most cases are considered idiopathic or immune-mediated, a small but important proportion are associated with malignant neoplasms, with implications for prognosis and management. The present study describes the case of a 69-year-old man who presented to the emergency department of the Virgen de las Nieves University Hospital (Granada, Spain), with a 2-week history of epigastric pain, vomiting and altered bowel habits. Laboratory investigations revealed previously undiagnosed renal insufficiency. An abdominal computed tomography (CT) scan showed extensive diffuse retroperitoneal infiltration extending from the periduodenal region to the pubic bone, resulting in gastric dilatation and hydronephrosis. A CT-guided retroperitoneal biopsy was performed and pathology confirmed the presence of urothelial carcinoma. This diagnosis led to the initiation of a chemotherapy regimen consisting of carboplatin and gemcitabine specifically designed for urothelial carcinoma. A follow-up 18F-FDG PET scan performed 6 months later showed a partial functional response. This case illustrates a rare presentation of urothelial carcinoma masked by extensive retroperitoneal fibrosis, and highlights the importance of accurate diagnosis in reducing tumor burden and improving the clinical status of patients.
PubMed: 38495831
DOI: 10.3892/ol.2024.14328 -
Radiation Oncology (London, England) Mar 2024The addition of radiation therapy (RT) to surgery in retroperitoneal sarcoma (RPS) remains controversial. We examined practice patterns in the use of RT for patients...
BACKGROUND
The addition of radiation therapy (RT) to surgery in retroperitoneal sarcoma (RPS) remains controversial. We examined practice patterns in the use of RT for patients with RPS over time in a large, national cohort.
METHODS
Patients in the National Cancer Database (2004-2017) who underwent resection of RPS were included. Trends over time for proportions were calculated using contingency tables with Cochran-Armitage Trend test.
RESULTS
Of 7,485 patients who underwent resection, 1,821 (24.3%) received RT (adjuvant: 59.9%, neoadjuvant: 40.1%). The use of RT decreased annually by < 1% (p = 0.0178). There was an average annual increase of neoadjuvant RT by 13% compared to an average annual decrease of adjuvant RT by 6% (p < 0.0001). Treatment at high-volume centers (OR 14.795, p < 0.0001) and tumor > 10 cm (OR 2.009, p = 0.001) were associated with neoadjuvant RT. In contrast liposarcomas (OR 0.574, p = 0.001) were associated with adjuvant RT. There was no statistically significant difference in overall survival between patients treated with surgery alone versus surgery and RT (p = 0.07).
CONCLUSION
In the United States, the use of RT for RPS has decreased over time, with a shift towards neoadjuvant RT. However, a large percentage of patients are still receiving adjuvant RT and this mostly occurs at low-volume hospitals.
Topics: Humans; United States; Radiotherapy, Adjuvant; Sarcoma; Liposarcoma; Combined Modality Therapy; Retroperitoneal Neoplasms; North America; Soft Tissue Neoplasms; Retrospective Studies
PubMed: 38491404
DOI: 10.1186/s13014-024-02407-8 -
World Journal of Urology Mar 2024To investigate the safety and feasibility of using a novel purpose-built single-port robotic system (the SHURUI Robotic Surgical System) with deformable surgical...
OBJECTIVE
To investigate the safety and feasibility of using a novel purpose-built single-port robotic system (the SHURUI Robotic Surgical System) with deformable surgical instruments to perform retroperitoneal single-port partial nephrectomy.
MATERIALS AND METHODS
A prospective study was conducted to recruit patients with a single renal tumor no more than 4 cm. Robot-assisted single-port partial nephrectomy was performed by using the novel purpose-built single-port robotic system with deformable surgical instruments. Patients' demographics, tumor characteristics, and perioperative parameters were recorded and analyzed.
RESULTS
Sixteen patients were recruited to the study. The median tumor size was 2.0 cm (IQR: 1.2-2.4 cm). The median R.E.N.A.L score was 6 (IQR: 4-4.5). In 3 cases, pure single-port surgery was carried out, and all the assistance was through the robotic port. Median docking time was 15.5 min (IQR: 14.25-22.25 min). Median operating time was 148.5 min (IQR: 178-238.5 min). Median console time was 107 min (IQR: 92.75-149.75 min). Median warm ischemic time was 26.5 min (IQR: 24.5-30 min). Median blood loss was 17.5 ml (IQR: 10-50 ml).
CONCLUSIONS
Retroperitoneal partial nephrectomy can be safely performed with this novel purpose-built single-port robotic system (SHURUI) with deformable surgical instruments. Further studies are needed to fully evaluate the role of this new platform.
Topics: Humans; Robotics; Robotic Surgical Procedures; Prospective Studies; Kidney Neoplasms; Nephrectomy; Treatment Outcome; Retrospective Studies
PubMed: 38478100
DOI: 10.1007/s00345-024-04827-3 -
Endoscopy Dec 2024
Topics: Humans; Gastric Fundus; Retroperitoneal Neoplasms; Neurilemmoma; Pressure
PubMed: 38467351
DOI: 10.1055/a-2271-4028 -
Asian Journal of Surgery May 2024
Topics: Adult; Female; Humans; Retroperitoneal Neoplasms; Teratoma; Tomography, X-Ray Computed
PubMed: 38458867
DOI: 10.1016/j.asjsur.2024.02.050