Does tumor rupture during robot-assisted partial nephrectomy have an impact on mid-term tumor recurrences?

BACKGROUND: Intraoperative kidney tumor rupture (TR) can occur during robot-assisted partial nephrectomy (RAPN) in daily clinical practice, but there are no solid guidelines on the management and implications of it. The purpose of the study was to investigate the impact of TR on tumor recurrences, what a surgeon should do if this adverse event occurs, and how to avoid it. PATIENTS AND METHODS: We retrospectively analyzed the first 100 patients who underwent RAPN at University Medical Centre Ljubljana, between 2018 and 2021. Patients were stratified into 2 groups (TR and no-TR) and were compared according to patient, tumor, pathologic, perioperative and postoperative characteristics and tumor recurrences, using the Mann-Whitney U test and chi-squared test. RESULTS: Of the 100 patients, 14 had TR (14%); this occurred in tumors with higher RENAL nephrometry scores (P = 0.028) and mostly with papillary renal cell carcinomas (P = 0.043). Median warm ischemia time was longer for the TR group (22 vs. 15 min, P = 0.026). In terms of studied outcomes, there were no cases of local or distant recurrence after a median observation time of 39 months (interquartile range, 31-47 months) in both groups. We observed positive surgical margins on the final oncologic report in one case in the no-TR group. CONCLUSIONS: Tumor rupture during RAPN seems to be of no mid-term oncologic importance. According to presented results, we would recommend surgeons to proceed with tumor resection if this event occurs and abstain from conversion to radical nephrectomy or open partial nephrectomy. However, more similar cases should be studied to make more solid conclusions.

A Rare Case Report of the Use of Allium Stent in Management of a Gunshot Injury with Incomplete Tear of the Proximal Part of the Right Ureter.

Background: Injuries to the ureter resulting from external trauma are uncommon. This type of injury is associated with a high mortality rate because of the involvement of concomitant multiorgan damage. Wound management depends primarily on the location and severity of the injury. In this study we present an example of Allium™ stent usage in a management of a rare type of injury with positive results. Case Presentation: The case involves a Caucasian man, 46 years of age, the victim of multiple gunshot injury. One bullet struck the abdomen and caused a multiple organ injury. The first surgery revealed a perforation of the duodenum and two perforations of the small bowel. On the second surgery, urea and creatinine were found in the excretion of abdominal drains. A CT scan identified an incomplete tear of the proximal part of the right ureter. The lesion was temporarily managed by insertion of a percutaneous nephrostomy. We decided to use an Allium stent for definitive delayed repair, because it should be ideal for long-term ureteral stenting and easy to remove. Conclusion: Because of the serious injuries and associated complications the patient had undergone three laparotomies and other surgical procedures. With the use of minimally invasive procedures we succeeded to repair the tear of the ureter. We demonstrate that the use of Allium stent is appropriate and safe in the management of ureteral injuries that result from penetrating trauma. The case also underlines the importance of careful examination for potential ureteral injuries after perforating external trauma.

Tumor marker α-fetoprotein receptor does not discriminate between benign prostatic disease and prostate cancer.

BACKGROUND: The α-fetoprotein receptor (RECAF) is a proposed novel tumor marker for detecting several different types of tumors, including prostate cancer (PCa). OBJECTIVES: The aim of the study was to evaluate RECAF in discriminating benign prostatic conditions from PCa and to compare it with prostate-specific antigen (PSA). MATERIAL AND METHODS: A total of 64 patients with elevated serum PSA levels and/or abnormal digital rectal examination of the prostate referred to a tertiary center for transrectal ultrasound (TRUS) biopsy of the prostate were prospectively enrolled in the study from January 2009 to April 2010. Serum RECAF, total PSA (tPSA) and free PSA (fPSA) concentrations were measured. The results were correlated with histopathologic findings using the Mann-Whitney U test and Kruskal-Wallis χ2 test. RESULTS: The median RECAF concentration was 5.34 U/L in the benign pathology group of patients and 4.72 U/L in the malignant pathology group. The difference was not statistically significant. RECAF density, tPSA and fPSA concentrations and tPSA density were significantly different between the benign and malignant pathology groups (p = 0.033, p = 0.000, p = 0.002 and p = 0.000, respectively). RECAF concentration and RECAF density did not differ significantly in the subgroups of PCa patients stratified according to Gleason score, predominant primary Gleason grade or maximum primary Gleason grade, but in predominant secondary Gleason grade and maximum secondary Gleason grade, significant differences were found (p = 0.007 and p = 0.004, respectively). CONCLUSIONS: The results of the study did not confirm the RECAF tumor marker as an alternative way to discriminate between groups of patients with benign prostatic conditions and PCa, and its concentration and density do not differ among PCa histopathologic groups.