[Short and medium term oncological results after robot-assisted prostatectomy: a comparative prospective non randomized study]. / Risultati oncologici a breve-medio termine dopo prostatectomia robotica: studio comparativo prospettico non randomizzato.

BACKGROUND: Our aim was to compare both the perioperative and the short/medium-term post-operative oncological results after radical prostatectomy between two groups of prostate cancer patients: one group treated with radical retropubic prostatectomy (RRP), the other one with robot-assisted laparoscopic prostatectomy (RALP). METHODS: We collected all the clinical, surgical, pathological and follow-up data of the patients who underwent radical prostatectomy with the two different surgical methods in a dedicated database. The positive surgical margins were defined by the presence of disease at the resection margin marked with China ink. The biochemical persistence of disease was defined as a PSA value >0.1 ng/mL 30 days after surgery, while the biochemical recurrence of the neoplasia was defined as a PSA value >0.2 ng/mL. RESULTS: The positive surgical margins (PSM) were identified as follows: 29.3% (RRP) versus 25.4% (RALP) in pT2 cancer (p 0.563), and 63.6% (RRP) versus 50.0% (RALP) in case of >pT2 cancer (p 0.559). If stratified by surgical approach, the results are: 53.3% (RRP) versus 25.6% (RALP) (p <0.001) in case of nerve-sparing technique. The persistence of disease is detectable in 5.4% (RRP) versus 4.6% (RALP), while the data on biochemical recurrence are: 2.7% (RRP) versus 0% (RALP). CONCLUSIONS: In our experience, in two groups of patients matched for clinic-pathological features who underwent RRP and RALP, oncological results are slightly better in the second group; this figure is even more significant when evaluating surgeries conducted with nerve-sparing technique. In this study we analyzed data of RALP, recently introduced in our center, comparing with RRP, a surgical technique consolidated through the decades. Therefore it can be said that even during the learning curve, RALP provides oncological results comparable to RRP.

Robot-assisted laparoscopic removal of perirenal lymphangioma: a case report.

The lymphangioma is a congenital malformation caused by abnormal development of the lymphatic vessels. The perirenal lymphangioma is extremely rare, and very few cases have been described in literature. A case of retroperitoneal perirenal lymphangioma is reported. Following recurring episodes of colic-like, right side back pain, a 16 year woman underwent an ultrasound which detected a multiloculated cystic lesion of 5 x 1 cm surrounding the lower pole of the right kidney. Subsequently a CT scan and an MRI detected, in the right perirenal space, a liquid multiloculated lesion, with no enhancement. Surgery was performed using the Da Vinci robotic system with transperitoneal access. Once dissection was concluded it was possible to identify a lymphatic duct coming from the renal pedicle, which likely drained the lesion, and selectively close it using clips. In conclusion, the cystic lymphangioma, must be considered among the differential diagnoses of retroperitoneal cystic lesions. These rare tumours have an excellent prognosis, with full remission of the symptomatology following complete surgical excision.

[Ductal carcinoma of the prostate: impact on survival and therapeutic controversies of a rare tumor]. / Carcinoma duttale della prostata: impatto sulla sopravvivenza e controversie terapeutiche di un tumore raro.

Prostate cancer is a disease with a variable clinical course. The possible impact on oncological outcome of non-acinar prostate cancer has not been established yet, especially for ductal adenocarcinoma due to its low frequency, so that its clinical management is not well codified. The disease occurs more often already at an advanced stage of diagnosis, with clinically detectable tumors and advanced pathological stage, partly because of the lack of specific tumor markers, given the poor correlation between PDA and PSA values. In the period between 1997 and 2010 56 patients with PDA on a total of 1265 new diagnoses of cancer were identified, for an overall incidence of 4.5%. 41 patients (75%) had a PDA type II histology, while 15 patients (25%) a PDA type I (pure form). Generally, a surgical treatment was carried out in patients with life expectancy greater than 10/15 years/under 70 years of age, non-metastatic tumors and found to be liable to local resection; radiation therapy was given with 70 Gy in cases with a shorter life expectancy and/or an illness judged unresectable for local extension; hormonal therapy was indicated in all other clinical situations. For all patients, the clinical and pathologic data and follow-ups were re-evaluated. The overall survival and disease-free survival were then analyzed. Given the low incidence of this pathology the relevant literature is poor and therefore the therapeutic approach is not univocal. This paper retrospectively reviews our experience with prostatic ductal adenocarcinoma.

Role of ¹¹C-choline positron emission tomography/computed tomography in evaluating patients affected by prostate cancer with suspected relapse due to prostate-specific antigen elevation.

PURPOSE: The aim of this study was to evaluate the accuracy of (11)C-choline positron emission tomography/computed tomography (PET/CT) in restaging patients affected by prostate cancer and suspected relapse due to prostate-specific antigen (PSA) increase. We also aimed to determine a PSA cutoff that is most suited to the study in terms of best compromise between sensitivity and specificity. Secondary endpoints were a comparison between (11)C-choline PET/CT and histological results, clinical findings, and radiological imaging (CT and magnetic resonance imaging). MATERIALS AND METHODS: We retrospectively evaluated 210 patients (median ± SD age 70 ± 7 years) affected by prostate cancer who underwent (11)C-choline PET/CT. RESULTS: (11)C-choline PET/CT imaging was positive in 116 (55.2%) patients and negative in 94 (44.8%). Receiver operating characteristic (ROC) analysis showed that the highest accuracy (sensitivity 76.8%, specificity 92.5%) for the whole population was achieved when the PSA level of 1.26 ng/ml level was used as the cutoff value for interpreting the results (P = 0.0001 and the area under the ROC curve AUC 0.897). For patients treated with surgery or surgery plus radiotherapy the cutoff was 0.81 ng/ml (sensitivity 73.2%, specificity 86.1%). For patients treated with radiotherapy alone, the cutoff was 2.0 ng/ml (sensitivity 81.8%, specificity 92.9%). CONCLUSION: Our results indicate that (11)C-choline PET/CT is a useful diagnostic tool in patients affected by prostate cancer and a relapsed PSA level. The highest accuracy for all patients is obtained with a PSA cutoff level of 1.26 ng/ml, above which the imaging study is performed (0.81 ng/ml for patients treated with surgery or surgery plus radiotherapy and 2.0 ng/ml for patients treated with radiotherapy alone).