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Objective:To investigate the safety and prognosis of partial nephrectomy (PN) in the treatment of highly malignant non-clear renal cell carcinoma (nccRCC).Methods:Clinical data of 47 patients with cT 1N 0M 0 high malignant nccRCC treated in Changhai Hospital from March 2016 to March 2022 were retrospectively analyzed. All patients received PN. There were 34(72.3%) males and 13(27.7%) females. The mean age was (53.5±15.0) years, and average BMI, was(23.7±3.4)kg/m 2.The maximum tumor diameter was (29.8±12.6) mm, and R. E.N.A.L. score was 7(5-9), with 37(78.7%) cases of T 1a and 10(21.3%) cases of T 1b. The mean estimated glomerular filtration rate (eGFR) before surgery was (96.3±25.5) ml/ (min·1.73m 2). All patients underwent PN, including 1 patient (2.1%) undergoing open surgery, 29 patients (61.7%) undergoing laparoscopic surgery, and 17 patients (36.2%) undergoing robotic surgery. There were a total of 22(46.8%) cases of papillary cell carcinoma(pRCC)type Ⅱ, 4(8.5%) cases of collecting duct carcinoma (cdRCC), 9(19.1%) cases of MiT family translocated renal cell carcinoma (tRCC), 5(10.6%) cases of mucoid tubular and spindle cell carcinoma (mtSCC)and 7(14.9%) cases of unclassified renal cell carcinoma (uRCC). The surgical conversion rate, positive margin rate, operative time, intraoperative blood loss, complications, and postoperative hospital stay were analyzed. Preoperative and postoperative eGFR were analyzed, and overall survival (OS) and cancer specific survival (CSS) were calculated. Results:All the operations were successfully completed. No radical operation or open operation was performed, with operation time of(100±60) min and intraoperative blood loss of(100±59) ml. There were no intraoperative complication and 1 case (2.1%) suffered from postoperative complication. Postoperative hospital stay were 5 (4-6) days. The mean eGFR after surgery was (86.5±27.1) ml/(min·1.73m 2), and the difference was statistically significant ( P=0.041). In this study, the mean follow-up time was (45.7±20.9)months, and no adjuvant therapy was used after surgery. During the follow-up period, 2 patients died, who all of them were kidney cancer-related death, and both OS and CSS were 95.7% (45/47). Conclusions:PN is safe, feasible and has a good prognosis in the treatment of high malignant T 1 nccRCC. For tumors with clear imaging boundaries and complete envelope, complete tumor resection is more likely, postoperative follow-up should be strict, and no remedial radical or systemic treatment was required.
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Objective To analyze the safety and effectiveness of robot-assisted laparoscopic partial nephrectomy(RLPN) for cT2 renal tumors in international multi-centers.Methods This study was conducted to collect information on surgical procedures performed by RLPN and robot assisted laparoscopic radical nephrectomy (RRN) in nineteen international urological centers from January 2012 to December 2017.RLPN were performed in 159 patients (118 males and 41 females),with the average age of (59.3 ± 13.2) years,body mass index(BMI) of (28.7 ± 5.4)kg/m2,preoperative GFR of (77.3 ± 22.1) ml/min.RRN were performed in 219 patients,with the average age of (62.0 ± 12.9) years,BMI of (28.7 ±6.1) kg/m2,preoperative GFR of (71.4 ± 20.3) ml/min.There was no statistical difference between the two groups in gender and BMI.The age of the patients in RLPN group was younger than that in RRN group,and the preoperative GFR was better.The patient's baseline demographics,perioperative data,tumor pathology,oncologic outcomes,and renal function (GFR) were recorded.Results All 378 cases underwent successful surgery.The operation time of RLPN was 150 min(65-353 min),which was shorter than that of RRN [180 min(85-361 min),P ＜ 0.001].The intra-operative blood loss of RLPN was more than that of RRN [150 ml (40-3 000 ml) vs.100 ml (10-1 100 ml),P ＜ 0.001].The incidence of intra-operative complications were not statistically different between the two groups [5.7％ (9/159) vs.3.2％ (7/219),P =0.240].The incidence of postoperative complications was higher in the RLPN group than that in RRN group [19.5％ (31/159) vs.10.5％ (23/219),P =0.014],but there was no significant difference in the incidence of complications of grade 3 or above [4.4％ (7/159) vs.2.3％ (5/219),P =0.246].The recurrence-free survival rate of RLPN group was higher than that of RRN group [91.4％ (117/128) vs.81.9％ (167/204),P =0.013],and RLPN group was more conducive to renal function protection (P ＜ 0.001).Conclusions RLPN for cT2 tumors can obtain effective tumor control rate and better renal function preservation.It could be an acceptable alternative for surgical management of cT2 tumors.
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Objective To evaluate the feasibility and effectiveness of the application of IQQA (Intelligent/interactive Qualitative and Quantitative Analysis) three-dimensional reconstruction technique in precise laparoscopic or robot-assisted laparoscopic partial nephrectomy (LPN or RAPN) for renal hilar tumors.Methods The study retrospectively reviewed 11patients with hilar tunors from February 2016 to February 2017.Of the 11 patients,4 were women and 7 were men,with an average age of 51 years (range 38 to 70 years).The average tumor size was 3.1 cm (range 1.7 to 4.3 cm).For tumor stage,9 patients were in T1a stage and 2 patients were in T1b stage.Tbe average R.E.N.A.L score was 8.7 (range 7 to 10).The mean preoperative GFR was 40.6 ml/min (range 32 to 45 ml/min).IQQA three-dimensional reconstruction technique was applied for the purpose of precise navigation and resection of the tumors.Multivariate analysis was used to identify predictors of warm ischemia time,estimated blood loss,major perioperative complications,and postoperative renal function.Results All 11 laparoscopic or robot-assisted laparoscopic hilar partial nephrectomies were successfully completed without conversion to a hand-assisted or an open approach.Under the navigation of IQQA,all tumors were found precisely at the first time during surgeries.The final pathologic examination revealed that all the 11 patients were clear cell renal cell carcinomas.The mean operative time was 142 minutes (range 90 to 230 minutes),with a mean warm ischemia time of 24 minutes (range 17 to 33 minutes).The estinated blood loss was 146 ml (range 50 to 400 ml).No intraoperative complications occurred.Two patients suffered from postoperative complications.One patient with gross hematuria was recovered by consistent bladder irrigation.The other patient with postoperative hemorrhage needed transfusion.All patients had negative margins on the final pathologic examination.At a mean follow-up period of 3 months,the mean GRR is 22.5 ml/min (range 13 to 34 ml/min) without any disease recurrence.Conclusions With peculiar features,such as accurate location,complete resection and fewer perioperative complications,the application of IQQA three-dimensional reconstruction technique in precise partial nephrectomy represents a safe and effective procedure for hilar tumors.
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Objective To study the short-term effectiveness of robotic-assisted laparoscopic radical prostatectomy in high-risk prostate cancer.Methods From March 2012 to March 2017,400 patients with high-risk prostate who underwent robotic-assisted laparoscopic radical prostatectomy were reviewed.The median age was 68 years old(ranged from 49 to 83 years),and the median PSA was 23.1 ng/ ml(ranged from 5.2 to 999.0 ng/ml).Preoperative parameters,surgical interventional data,postoperative pathology and follow-up data were collected.Logistic regression was used to analyze the risk factors of positive surgical margin in postoperative pathology.Results All the operations were successfully completed.Median operation time was 115 min(ranged 50-555 min),and median estimated blood loss was 110 ml(ranged 30-500 ml).Six patients had perioperative complications,among which two were rectal injury,two were cardio-cerebrovascular disease and two were hemorrhage.There was no perioperative death.Positive surgical margin was detected in 151 patients,accounting for 37.8％.A total of 345 cases (86.3％) underwent lymphadenectomy,of which 253 cases (63.3％) were performed standardized resection and 92 cases (23％) were performed extensive resection.The median number of resected lymph nodes was 9 (ranged 3-36).Eighty cases (23.2％,80/345) were positive in resected lymph nodes.Regression analysis showed that preoperative PSA ＞ 20 ng / ml or clinical stage ≥ T2c were risk factors for positive surgical margins.After a median follow-up of 14.4 months (ranged 2.0-58.8 months),the overall incidence of biochemical recurrence was 33.4％ (107/320),and the urinary continence rate one year after operation was 86.6％ (277/320).Conclusions Robotic-assisted laparoscopic radical prostatectomy in patients with high-risk prostate cancer was a feasible,safe and effective approach.Preoperative PSA and clinical stage were the risk factors for positive surgical margin.
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Objective To compare the degree of atherosclerosis in middle-aged versus elderly patients with chronic kidney disease (CKD),and to explore the relationship between inflammatory molecules in venous blood and atherosclerosis.Methods Totally 87 elderly patients and 64 middleaged patients with CKD were selected.The vein fasting blood samples were taken in the morning.Serum levels of interleukin (IL)-18,IL-6,tumor necrosis factor (TNF-α),high-sensitivity C-reactive protein (hs-CRP) were measured by enzyme-linked immunosorbent assay (ELISA) and ankle-brachial pulse wave conduction velocity (baPWV) was detected.Results Inflammatory molecules such as IL-18,IL-6,TNF-α and hs-CRP levels in venous blood were increased with the severity of CKD in both two groups,and the levels of inflammatory molecules were higher in elderly group than in middle-aged group.There was a signifiant difference in the detection rate of patients with baPWV＞1400 cm/s between elderly group and middle-aged group [30 cases (34.5％) vs.11 cases (17.2％),x2 =5.58,P＜0.05].The prevalence of PWV＞1400 cm/s was higher in patients with hyperlipidemia and hypertension than in patients with diabetes or heart disease (elderly group:100％,100％ vs.45.5％,40％; middle-aged group:80％,100％ vs.28.6％,33.3％,respectively; P＜0.05).The inflammatory protein (IL-18,IL-6,TNF-α and hs-CRP) levels were significantly higher in patients with baPWV＞ 1400 cm/s than those with baPWV ＜ 1400 cm/s (P＜0.05).Conclusions The degree of atherosclerosis is more severe in elderly CKD patients than in middle-aged CKD patients,which needs to be taken seriously enough.
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Objective To summarize the surgical experience in robotic-assisted laparoscopic partial nephrectomy,and to investigate the efficacy and safety of this surgery.Methods The clinical data of 12 patients who underwent robot-assisted laparoscopic partial nephrectomy in Changhai Hospital from March to July in 2012 were analyzed.All the patients were male and the age range was 43-66 years.In 4 cases the tumors were in the left kidney,and 8 in the right.In 7 cases the tumors were in the dorsal part of the kidney,and 2 in the ventral part.There were 3,5 and 4 cases in the upper,middle and lower pole of the kidney respectively.Preoperative GFR test was normal in all cases.Kidney CT scan showed the maximum diameters of the tumors were 2.0-5.8 cm,with an average of 3.3 cm.The pre-operative stages in all cases were T1N0M0.Results The surgery was successfully completed in all cases.The mean duration of the surgery was 160-310 min,with an average of 242 min.The blood loss was 30-300 ml,with an average of 135 ml,and the intraoperative blood transfusion was unnecessary.The warm ischemia time was 20-49 min,with an average of 31 min.There was no intraoperative morbidity,and no conversion to open surgery.The postoperative length of hospitalization was 9-31 d,with an average of 14 d.Gross hematuria arose in 1 patient at 1 week after the surgery.The post-operative pathology showed renal clear cell carcinoma with Furhman Grade Ⅱ in 11 cases,and renal angiomyolipoma in 1 case.The maximum diameters of the tumors were 2.0-5.0 cm,with an average of 3.5 cm.The tumor resection margin was negative in all cases.Conclusions Robot-assisted laparoscopic partial nephrectomy is safe and effective for local renal tumors.This surgery has significant advantage over traditional laparoscopic partial nephrectomy,in terms of the resection of the renal tumors and the reconstruction of the kidney.
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Objective To evaluate the efficacy and safety of long-term administration of tamsulosin hydrochloride 0.2 mg once daily in patients with LUTS of BPH. Methods Patients with LUTS of BPH enrolled in a 4-week placebo run-in period, then 60-week open-label study. Tamsulosin hydrochloride 0.2 mg was administered before breakfast every day during the period of the study. The efficacy and safety parameters were evaluated at the end of treatment period Ⅰ (0-12 weeks). If IPSS was improved by 25% or more, the administration of tamsulosin hydrochloride was continued during treatment period Ⅱ (13-60 weeks). If the improvement rate less than 25%, the patients received concomitant medication of finasteride 5 mg once daily during treatment period Ⅱ. The primary parameters assessed to determine efficacy were the International Prostate Symptom Score(IPSS) and maximum urinary flow rate(Qmax). Results A total of 113 patients were recruited in the study, and 111 patients completed treatment period Ⅰ , and 95 patients completed treatment period Ⅱ. After treatment period Ⅰ , average IPSS was decreased by 4.1 and average Qmax was increased by 1.7 ml/s(P＜0.05). Tamsulosin hydrochloride produced a great improvement in average Qmax (3.0 ml/s, 27.7%)and a significant decrease in average IPSS (6.4,30.3%) after 60-week treatment. Significant improvements were also produced in average urinary flow rate and average residual urine volume. There was no significant difference in changes in IIEF-5 score and the prostate volume after treatment with tamsulosin hydrochloride. During the study period, 13 patients experienced 24 adverse events, and the incidence of adverse event was 11.5%. No serious adverse event and significant changes of the data of laboratory examination were recorded during the study. Conclusions Long-term tamsulosin hydrochloride therapy is a safe, effective and well-tolerated method in improving symptoms and quality of life in patients with LUTS of BPH. Tamsulosin hydrochloride can be used as the conventional drug in the patients with LUTS suggestive of BPH.
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Objective To report the experience on the ureteroscopic treatment of ureteral fibro-epithlial polyp by Holmium:YAG laser resection.Methods Of five cases,the polyp was located in the upper 1 third of the ureter in 2 cases,and in middle 1 third or ureter in 2 cases,in lower 1 third of ureter in 1 case.The length of the polyps ranged from 3 to 16 cm.Three patients presented with flank pain,4 with hematuria and 1 with hydronephrosis.Five patients underwent rigid ureteroscopic treat-ment.TUR was performed in the 2 polyp cases with prolapsing from the ureteral orifice.A Holmium:YAG laser was used to resect ureteral polyps.At the end of the procedure,a 7 F double-J ureteral stent was placed and indwelling for 6- 8 weeks.Results All operations were successfully done.The pathologic diagnosis were fibroepithelial polyp.Histologically,the polyps were composed of a central fibrovascular core surrounded by hyperplastic benign urothelium.The stroma of polyp consis-ted of fibrous connective tissue with minimal cellular infiltration,and occasional epithelial cell nests were seen.The average length of hospital stay was 3 d (range 2 to 5).The mean follow-up was 24 months (range 3 to 51),and all patients remained no recurrence.One patient developed a ureteral stricture 3 months after the treatment,and relieved by endoscopic incision by Holmium:YAG laser.Conclusion Endoscopic management of ureteral fibroepithelial polyps could be a treatment modality with minimal morbidity and good treatment results.