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Yamagata Y, Abe T, Iwahara N, Takada K, Hida Y, Takakuwa E, Kikuchi H, Matsumoto R, Osawa T, Shinohara N. Metastatic neuroendocrine carcinoma of right adrenal gland successfully treated with laparoscopic adrenalectomy after multimodal therapy. IJU Case Rep 2022; 5:446-450. [PMID: 36341189 PMCID: PMC9626314 DOI: 10.1002/iju5.12511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 07/13/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction We report a case of laparoscopic adrenalectomy in a salvage setting after multiple chemotherapies for neuroendocrine carcinoma. Case presentation A 49‐year‐old man was diagnosed with unknown primary carcinoma with single brain metastasis, and right supraclavicular and mediastinal lymph node metastases. After stereotactic radiotherapy of the brain metastasis and systemic chemotherapy, lymphadanectomy was performed. The pathologic diagnosis was neuroendocrine carcinoma. At 11 months after surgery, computed tomography revealed right adrenal metastasis. Local radiotherapy initially resulted in complete remission. However, adrenal recurrence was noted 10 months later. Laparoscopic adrenalectomy was performed with curative intent. The patient is currently alive without recurrence at 20 months after the operation. Conclusion Adrenalectomy can become a treatment option if other metastases are well‐controlled with systemic therapy. Surgical elimination of oligometastases can offer long‐term disease control in selected patients as part of a multimodal approach.
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Affiliation(s)
- Yusuke Yamagata
- Department of Urology Hokkaido University Graduate School of Medicine Sapporo Japan
| | - Takashige Abe
- Department of Urology Hokkaido University Graduate School of Medicine Sapporo Japan
| | - Naoya Iwahara
- Department of Urology Hokkaido University Graduate School of Medicine Sapporo Japan
| | - Kohichi Takada
- Department of Medical Oncology Sapporo Medical University School of Medicine Sapporo Japan
| | - Yasuhiro Hida
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine Hokkaido University Sapporo Japan
| | - Emi Takakuwa
- Department of Surgical Pathology Hokkaido University Hospital Sapporo Japan
| | - Hiroshi Kikuchi
- Department of Urology Hokkaido University Graduate School of Medicine Sapporo Japan
| | - Ryuji Matsumoto
- Department of Urology Hokkaido University Graduate School of Medicine Sapporo Japan
| | - Takahiro Osawa
- Department of Urology Hokkaido University Graduate School of Medicine Sapporo Japan
| | - Nobuo Shinohara
- Department of Urology Hokkaido University Graduate School of Medicine Sapporo Japan
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Recurrence in prostate cancer: salvage diagnostic and therapeutic strategies. World J Urol 2019; 37:1467-1468. [DOI: 10.1007/s00345-019-02778-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Bonet X, Ogaya-Pinies G, Woodlief T, Hernandez-Cardona E, Ganapathi H, Rogers T, Coelho RF, Rocco B, Vigués F, Patel V. Nerve-sparing in salvage robot-assisted prostatectomy: surgical technique, oncological and functional outcomes at a single high-volume institution. BJU Int 2018; 122:837-844. [PMID: 30126045 DOI: 10.1111/bju.14517] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To show the feasibility, oncological and functional outcomes of neurovascular bundle (NVB) preservation during salvage robot-assisted radical prostatectomy (RARP). PATIENTS AND METHODS In the present institutional review board-approved retrospective analysis, between January 2008 and March 2016, 80 patients underwent salvage RARP, performed by a single surgeon (V.P), because of local recurrence after primary treatment. These patients were categorized into two groups depending on the degree of nerve-sparing (NS) performed: a good-NS group (≥50% of NVB preservation) and a poor-NS group (<50% of NVB preservation). A standard transperitoneal six-port technique, using the DaVinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA), was performed, and either an anterograde or a retrograde approach was used for NVB preservation. Validated questionnaires were used preoperatively (Sexual Health Inventory for Men [SHIM] and American Urological Association scores). Potency after salvage RARP was defined as the ability to achieve a successful erection with penetration >50% of the time, while full continence after salvage RARPwas defined as 0 pads used. The Kaplan-Meier method was used for survival and predictive estimations, and regression models were used to identify the predictors of potency, continence and biochemical failure (BCF). RESULTS The potency rate at 12 months was higher in the good-NS group (25.6% vs 4.3%; P = 0.036) regardless of previous SHIM score, and good NS tended to be predictive of potency after salvage RARP (P = 0.065). The full continence rate at 12 months and BCF rate were similar in the two groups, and non-radiation primary treatment was the only predictor of continence at 12 months after salvage RARP (P = 0.033). CONCLUSIONS Our data support the feasibility and safety of NVB preservation for salvage RARP conducted in select patients in a high-volume institution and the subsequent better recovery of adequate erections for intercourse.
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Affiliation(s)
- Xavier Bonet
- Hospital Universitari de Bellvitge, Barcelona, Spain.,Global Robotic Institute, Florida Hospital, Celebration, FL, USA
| | | | - Tracey Woodlief
- Global Robotic Institute, Florida Hospital, Celebration, FL, USA
| | | | | | - Travis Rogers
- Global Robotic Institute, Florida Hospital, Celebration, FL, USA
| | - Rafael F Coelho
- Global Robotic Institute, Florida Hospital, Celebration, FL, USA.,University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Bernardo Rocco
- Global Robotic Institute, Florida Hospital, Celebration, FL, USA.,Fondazione IRCCS Ca' Grande Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Vipul Patel
- Global Robotic Institute, Florida Hospital, Celebration, FL, USA
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[Salvage radical prostatectomy for recurrent prostate cancer. Morbidity, oncological and functional results]. Prog Urol 2017; 27:458-466. [PMID: 28576424 DOI: 10.1016/j.purol.2017.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 04/28/2017] [Accepted: 05/05/2017] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Salvage radical prostatectomy (sRP) for radiorecurrent prostate cancer (PCa) is a challenging procedure. To report our experience with sRP for selected patients with local recurrence after primary treatment for localised PCa. METHODS From 2005 to 2015, 24 patients underwent sRP for recurrent PCa in our center and were included in this retrospective study. Local recurrence was suspected by PSA increase>nadir+2ng/mL and was confirmed by biopsy. Perioperative complications according to Clavien-Dindo classification, oncological and functional results were analysed. RESULTS Overall, 24 patients with a median age of 59 years (IQR: 55-60) were included. Median follow-up was 25 months (IQR: 9-26). Procedures were performed with open-retropubic approach in 50 % and robot-assisted laparoscopic approach in 50 %. Overall, 5 (21 %) and 2 (8 %) patients experienced grade≤IIIa and grade≥IIIb postoperative complication, respectively. Surgical margins were positive in 46 % of cases. Three out of 4 patients with postoperatively detectable PSA (>0.2ng/mL) had positive surgical margins. Seven patients experienced biochemical recurrence in a median delay of 19 months (9-62). Seventy-one percent (5) of these patients experienced clinical recurrence in a median delay of 24 months (10-113). Severe urinary incontinence (≥3 pads/day) and erectile dysfunction were reported in 25 % and 63 %, respectively. CONCLUSION sRP for patients is a feasible procedure with encouraging local control rate and acceptable morbidity. This technique should be discussed as a treatment option for locally recurrent PCa in well-selected patients. LEVEL OF EVIDENCE 4.
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Di Pierro GB, Grande P, Mordasini L, Danuser H, Mattei A. Robot-assisted radical prostatectomy in the setting of previous abdominal surgery: Perioperative results, oncological and functional outcomes, and complications in a single surgeon's series. Int J Surg 2016; 36:170-176. [PMID: 27989916 DOI: 10.1016/j.ijsu.2016.10.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 10/25/2016] [Accepted: 10/25/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND Data on safety and efficacy of robot-assisted radical prostatectomy (RARP) after previous abdominal surgery are scarce. Hence, we assessed perioperative, oncological and functional outcomes, and complications of RARP in patients with previous abdominal surgery after 1-year minimum follow-up. MATERIALS AND METHODS Prospectively collected data from 339 consecutive patients undergoing transperitoneal RARP by a single surgeon (AM) between November 2008 and May 2014 were analysed. Complications were classified according to Modified Clavien System. Biochemical recurrence (BCR) was defined as two consecutive PSA values ≥ 0.2 ng/ml. Functional outcomes were assessed using validated, self-administered questionnaires. In particular, only patients undergoing nerve-sparing RARP with no erectile dysfunction (baseline IIEF-5 score >21) and no use of phosphodiesterase-5 inhibitors preoperatively who were interested in erections and required no adjuvant therapy (radiation, orchiectomy and androgen-deprivation therapy) were evaluated concerning potency recovery. Patients without and with previous abdominal surgery were compared using Mann-Whitney and chi-square tests (or Fisher exact test). RESULTS On 339 patients, 247 (71.6%) had not undergone previous abdominal surgery (Group 1) and 92 (28.4%) were pre-operated (Group 2). There were no statistically significant differences between Groups 1 and 2 regarding mean operative time (260 vs. 257 min; p = 0.597), median number of resected nodes (16 vs. 17; p = 0.484), mean length of stay (7.2 vs. 7.1 d; p = 0.151), positive surgical margin (12.5% vs. 16.3%; p = 0.233) and complication rates (26.7% vs. 31.5%; p = 0.187). Median (IQR) follow-up was 36 (12-48) months. For Groups 1 and 2, BCR-free survival rates were 78.5% and 79.8% (p = 0.467); continence rates were 97.9% and 100% (p = 0.329), whereas a potency recovery was achieved in 69.5% and 62.2% of patients (p = 0.460), respectively. CONCLUSIONS Transperitoneal RARP is a safe and efficient treatment for clinically localised prostate cancer even in patients with previous abdominal surgery. However, further studies with higher number of patients are warranted.
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Affiliation(s)
- Giovanni Battista Di Pierro
- Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland; Dept. of Obstetrics and Gynecology Sciences and Urologic Sciences, 'Sapienza' University, Rome, Italy.
| | - Pietro Grande
- Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland; Dept. of Obstetrics and Gynecology Sciences and Urologic Sciences, 'Sapienza' University, Rome, Italy.
| | - Livio Mordasini
- Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland.
| | - Hansjörg Danuser
- Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland.
| | - Agostino Mattei
- Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland.
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