ABSTRACT
Objective To investigate the long-term outcome of radical prostatectomy (RP) in the patients with incidental prostate cancer (IPCa) detected by surgery of benign prostatic hyperplasia (BPH) and to evaluate the risk factors for residual tumour after BPH surgery and biochemical recurrence in patients with IPCa treated with RP.Methods We retrospectively analyzed the clinical and follow-up data of 45 patients with IPCa detected by surgery of BPH and undergoing RP from January 2004 to October 2016.The age,PSA before and after BPH surgery,prostate volume,T stage and Gleason score after the BPH surgery,T stage at RP (pT0,pT2,pT3),Gleason score at RP and status of biochemical recurrence were recorded.Multivariate logistic regression analysis addressed the association between the factors and the presence of residual cancer after the surgery for BPH.Cox regression was used to analyzed the relationship between the factors and the rate of biochemical recurrence after RP.Results Among 45 IPCa patients,21 patients were stage T1a and 24 were stage T1b.After RP,7 (15.6％) patients had no residual tumor (pT0).PSA before BPH surgery (RR =2.58,95％ CI 1.27-5.42,P =0.04),PSA after BPH surgery (RR =4.26,95％ CI 2.57-7.64,P =0.01) and Gleason score after BPH surgery (RR =3.98,95％ CI 1.85-5.77,P =0.02) were significant associated factors with the residual cancer after BPH surgery.With a mean follow-up of 54 months(ranging 5-144 months),the 5-and 10-years.biochemical recurrence-free survival rates were 95.6％ and 86.7％,respectively.PSA after surgery for BPH (RR =4.79,95％ CI 2.57-7.64,P =0.02) and Gleason score after RP(RR =2.01,95％ CI 1.74-5.21,P =0.04) were the only independent risk factors for biochemical recurrence.Stage (T1a-T1b) did not predict residual cancer or the rate of biochemical recurrence (P ＞ 0.05).Conclusions RP in the patients with IPCa detected by BPH surgery had a good outcome of long-term oncological control.PSA before and after BPH surgery and Gleason score at BPH surgery were the significant associated factors of residual cancer after BPH surgery.PSA after BPH surgery and Gleason score at RP were the only independent risk factors for biochemical recurrence.
ABSTRACT
Objective To investigate the long-term outcome of radical prostatectomy (RP) in the patients with incidental prostate cancer (IPCa) detected by surgery of benign prostatic hyperplasia (BPH) and to evaluate the risk factors for residual tumour after BPH surgery and biochemical recurrence in patients with IPCa treated with RP.Methods We retrospectively analyzed the clinical and follow-up data of 45 patients with IPCa detected by surgery of BPH and undergoing RP from January 2004 to October 2016.The age,PSA before and after BPH surgery,prostate volume,T stage and Gleason score after the BPH surgery,T stage at RP (pT0,pT2,pT3),Gleason score at RP and status of biochemical recurrence were recorded.Multivariate logistic regression analysis addressed the association between the factors and the presence of residual cancer after the surgery for BPH.Cox regression was used to analyzed the relationship between the factors and the rate of biochemical recurrence after RP.Results Among 45 IPCa patients,21 patients were stage T1a and 24 were stage T1b.After RP,7 (15.6％) patients had no residual tumor (pT0).PSA before BPH surgery (RR =2.58,95％ CI 1.27-5.42,P =0.04),PSA after BPH surgery (RR =4.26,95％ CI 2.57-7.64,P =0.01) and Gleason score after BPH surgery (RR =3.98,95％ CI 1.85-5.77,P =0.02) were significant associated factors with the residual cancer after BPH surgery.With a mean follow-up of 54 months(ranging 5-144 months),the 5-and 10-years.biochemical recurrence-free survival rates were 95.6％ and 86.7％,respectively.PSA after surgery for BPH (RR =4.79,95％ CI 2.57-7.64,P =0.02) and Gleason score after RP(RR =2.01,95％ CI 1.74-5.21,P =0.04) were the only independent risk factors for biochemical recurrence.Stage (T1a-T1b) did not predict residual cancer or the rate of biochemical recurrence (P ＞ 0.05).Conclusions RP in the patients with IPCa detected by BPH surgery had a good outcome of long-term oncological control.PSA before and after BPH surgery and Gleason score at BPH surgery were the significant associated factors of residual cancer after BPH surgery.PSA after BPH surgery and Gleason score at RP were the only independent risk factors for biochemical recurrence.
ABSTRACT
Objective: To report our experience in the management of incidentally detected carcinoma gall bladder and establishment of a treatment protocol. Method: Retrospective review of 7 patients with incidentally detected carcinoma gall bladder during and after laparoscopic cholecystectomy for presumed benign disease. Clinical and histopathological data, treatment and long term outcome of all seven patients were reviewed. Exploratory laparotomy and radical surgery with curative intent consisting of liver resection, lymphadenectomy of the pedicle and excision of the port site were performed in all patients. Results: Liver resection including the segments IVB and V was done in 5 patients and in 2 patients resection of a wedge of hepatic parenchyma of more than 2 cm thickness including the gall bladder bed was carried out. Five patients underwent common bile duct excision with hepaticojejunostomy. Postoperatively, 2 patients developed fever and 1 patient had minimal altered blood in the nasogastric tube aspirate. These were successfully managed conservatively. All 7 patients had disease of pathological stage II and beyond. All patients received adjuvant chemotherapy. One patient died after 2 months of cholangitis and sepsis. One patient succumbed to metastatic disease after 12 months. The remaining patients are disease free on follow up. Conclusion: Re-exploration and aggressive resection with adjuvant chemotherapy for incidental carcinoma of the gallbladder is safe and offers hope for long term survival.