Is 3D laparoscopic off clamp simple enucleation a feasible alternative for clinical T1 renal tumors? Outcomes from a single center experience.

PURPOSE: To evaluate the safety of 3D laparoscopic off clamp simple enucleation (SE) of kidney tumors versus standard laparoscopic on-clamp partial nephrectomy (PN) in terms of perioperative, oncological and functional outcomes. METHODS: All patients that underwent 3D laparoscopic nephron sparing surgery (NSS) in our department for clinical T1 tumors between January 2019-September 2020 were included. Of the total of 84 patients, 38 (45.24%) underwent SE (SE group) and 46 (54.76%) PN (PN group). Perioperative data was collected and analyzed. Oncological outcomes were evaluated by the positive surgical margin (PSM) rate and follow-up at 6 months after surgery. RESULTS: Mean age, gender, tumor size, PADUA score and length of hospital stay were comparable between the two groups. Estimated intraoperative blood loss (284.21 ml vs 151.52 ml, p=0.0001) and hemoglobin drop (p=0.0001) were significantly lower for the PN group. Patients that underwent SE showed a better preservation of renal function (eGFR drop of 4.4 ml/min vs 1.78 ml/min, p=0.75). No significant differences were found regarding the PSM, although the PSM rate was lower in the SE group when compared with the PN group (2.63% vs 4.34%, p= 0.07). CONCLUSION: Off-clamp simple enucleation of renal masses is feasible by laparoscopic approach and has produced comparable oncologic outcomes with standard on-clamp partial nephrectomy, with an incremental advantage for the preservation of renal function.

3D laparoscopic enucleation vs standard partial nephrectomy for cT1 renal masses: assessment of functional outcomes at 1-year follow-up.

AIM: To evaluate renal function after laparoscopic nephron-sparing surgery (NSS) and to establish the factors that might influence its dynamic one year after surgery. METHODS: The prospective study included 83 patients previously diagnosed with renal cell carcinoma who underwent laparoscopic NSS. Demographic, clinical, laboratory and surgery related data were recorded. Patients were followed up for one year after surgery. RESULTS: The majority of cases (63 (76.8%)) were included in stage T1a. Almost two thirds of patients underwent partial nephrectomy (PN) (54 (65.1%)). A slight decrease in GFR was observed 1 year after surgery (80.1±21.5 ml/min; 75.3±22.4 ml/min respectively) in all patients. Univariate analysis showed a significant decrease in GFR values one year after surgery for patients who underwent standard PN as compared with those from the enucleation group (p=0.003). Male patients showed a significant decrease in GFR one year after surgery, as compared with female patients (p<0.001), and elderly patients were more likely to show lower GFR. When considering the simultaneous influence of age, gender and type of surgery on the evolution of GFR, the threshold for statistical significance was slightly crossed (p=0.2). CONCLUSION: Partial nephrectomy as compared to enucleation, advanced age and male gender are associated with impaired renal function at one year after laparoscopic NSS. KEY WORDS: Enucleation, Laparoscopic partial nephrectomy, Renal cell carcinoma.

Connecting the dots between different networks: miRNAs associated with bladder cancer risk and progression.

BACKGROUND: Bladder cancer (BC) is a common urothelial malignancy, characterized by a high recurrence rate. The biology of bladder cancer is complex and needs to be deciphered. The latest evidence reveals the critical role of the non-coding RNAs, particularly microRNAs (miRNAs), as vital regulatory elements in cancer. METHOD: We performed a miRNAs microarray using paired tissues (tumor and adjacent normal bladder tissue), followed by the validation with qRT-PCR of five selected transcripts. Additional next-generation sequencing investigation established the interconnection among the altered miRNAs and mutated genes. Based on the overlapping between TCGA data and data obtained in the study, we focused on the systematic identification of altered miRNAs and genes mutated involved in bladder cancer tumorigenesis and progression. RESULTS: By overlapping the miRNAs expression data, the two patient cohorts, we identified 18 miRNAs downregulated and, 187 miRNAs upregulated. qRT-PCR validation was completed using a selected panel of two downregulated (miR-139-5p and miR-143-5p) and three up-regulated miRNAs (miR-141b, miR-200 s or miR-205). Altered miRNAs patterns are interrelated to bladder tumorigenesis, allowing them to be used for the development of novel diagnostic and prognostic biomarkers. Three EMT-related upregulated miRNAs have an essential role in the molecular mechanisms, specifically key processes underlying tumorigenesis, invasion and metastasis. Using the Ampliseq Cancer Panel kit and Ion Torrent PGM Next-Generation Sequencing an increased mutation rate for TP53, FGFR3, KDR, PIK3CA and ATM were observed, but the mutational status for only TP53 was correlated to the survival rate. The miRNAs pattern, along with the gene mutation pattern attained, can assist for better patient diagnosis. CONCLUSION: This study thereby incorporates miRNAs as critical players in bladder cancer prognosis, where their altered gene expression profiles have a critical biological function in relationship with tumor molecular phenotype. The miRNA-mRNA regulatory networks identified in BC are ripe for exploitation as biomarkers or targeted therapeutic strategies.

Investigation of Renal Cell Carcinoma by Contrast-Enhanced Ultrasound- Predictive Value of Time Intensity Curve Analysis in Establishing Local Tumor Invasion and Stage: A Pilot Study.

PURPOSE: Contrast-enhanced ultrasound (CEUS) allows for real-time examination of signal intensity changes in a region of interest (ROI) and quantification of contrast agent kinetics. This study assessed the predictive ability of time-intensity curve (TIC) parameters for local tumor invasion and T stage of renal cell carcinoma (RCC). MATERIALS AND METHODS: Renal tumors in 41 patients were examined by CEUS. Thirty-two met the inclusion criteria, with a total of 33 tumors (27 clear cell, 4 chromophobe, and 2 papillary type I). Nineteen (57.6%) tumors were included in group A (stages pT1 and pT2) and 14 (42.4%) in group B (stage pT3). ROIs were established as: whole tumor (TuW); tumor area with the highest signal intensity (TuMAX) and renal cortex (Ref). The TIC param­eters for each ROI were calculated as below: peak signal intensity, time to peak (TTP), rise time (RT), and mean transit time (MTT). They were analyzed as a whole value for each ROI and as a ratio between the different ROIs. RESULTS: There were significant differences between the tumors invading and not invading the renal sinus fat for TTP (TuW/Ref) [0.98 (0.67-1.25) vs. 1.18 (1.08-1.3), P < .05]. For differentiation between groups A and B, the following ratios were proven as predictors by univariate regression analysis: TTP (TuMAX/TuW); MTT (Tu­MAX/TuW); RT (TuMAX/TuW) (P = .03, P = .01 and P = .02, respectively). The value derived from the Receiver Operating Characteristic (ROC) curve for RT (TuMAX/TuW) was 0.8 with sensitivity = 78.6%, specificity = 89.5%, and cutoff value of > 0.91. CONCLUSION: TIC parameters were predictors of locally noninvasive and invasive RCC.