Papillary type 2 versus clear cell renal cell carcinoma: Survival outcomes.

AIM: To compare the cancer specific survival (CSS) between p2-RCC and a Propensity Score Matched (PSM) cohort of cc-RCC patients. METHODS: Fifty-five (4.6%) patients with p2-RCC and 920 cc-RCC patients were identified within a prospectively maintained institutional dataset of 1205 histologically proved RCC patients treated with either RN or PN. Univariable and multivariable Cox regression analyses were used to identify predictors of CSS after surgical treatment. A 1:2 PSM analysis based on independent predictors of oncologic outcomes was employed and CSS was compared between PSM selected cc-RCC patients using Kaplan-Meier and Cox regression analysis. RESULTS: Overall, 55 (4.6%) p2-RCC and 920 (76.3%) cc-RCC patients were selected from the database; p2-RCC were significantly larger (p = 0.001), more frequently locally advanced (p < 0.001) and node positive (p < 0.001) and had significantly higher Fuhrman grade (p < 0.001) than cc-RCC. On multivariable Cox regression analysis age (p = 0.025), histologic subtype (p = 0.029), pN stage (p = 0.006), size, pT stage, cM stage, sarcomatoid features and Fuhrman grade (all p < 0.001) were independent predictors of CSS. After applying the PSM, 82 cc-RCC selected cases were comparable to 41 p2-RCC for age (p = 0.81), tumor size (p = 0.39), pT (p = 1.00) and pN (p = 0.62) stages, cM stage (p = 0.71) and Fuhrman grade (p = 1). In this PSM cohort, 5 yr CSS was significantly lower in the p2-RCC (63% vs 72.4%; p = 0.047). At multivariable Cox analysis p2 histology was an independent predictor of CSM (HR 2.46, 95% CI 1.04-5.83; p = 0.041). CONCLUSIONS: We confirmed the tendency of p2-RCC to present as locally advanced and metastatic disease more frequently than cc-RCC and demonstrated p2-RCC histology as an independent predictor of worse oncologic outcomes.

Trends in the use of partial nephrectomy for cT1 renal tumors: Analysis of a 10-yr European multicenter dataset.

AIM: Although extensively addressed in US registries, the utilization rate of Partial Nephrectomy has been poorly addressed in European settings. Our aim is to evaluate the impact of hospital volume on the use of PN for cT1 renal tumors. METHODS: 2526 patients with cT1N0M0 renal tumors treated with either PN or radical nephrectomy at 10 European centres in the last decade were included in the analysis. Joinpoint regression analysis was used to identify significant changes over time in linear slope of the trend for each center. The correlation between yearly caseload and the slopes was assessed with the non-parametric Spearman test. Coincident pairwise tests and regression analyses were used to generate and compare the trends of high-volume (HV), mid-volume (MV) and low-volume (LV) groups. RESULTS: Yearly caseload was significantly associated with increased use of PN (R = 0.69, p = 0.028). The utilization rate of PN was stable at LV centres (p = 0.67, p = 0.7, p = 0.76, for cT1, cT1a, and cT1b tumors, respectively), while increased significantly at MV (p = 0.002, 0.0005 and 0.007, respectively) and HV centers (all p < 0.0001). Regression analysis confirmed the trends for HV and MV as significantly different from those observed in LV centres (all p ≤ 0.002) and highlighted significant differences also between MV and HV centres (all p ≤ 0.03). CONCLUSIONS: We confirmed the association between caseload and the use of PN for cT1 tumors. Our findings suggest that a minimum caseload might turn the tide also in LV centres while a selective referral to HV centers for cT1b tumors should be considered.

Laparoscopic transperitoneal right adrenalectomy for 'large' tumors.

OBJECTIVES: We compared two different approaches to right laparoscopic transperitoneal adrenalectomy for large tumors (>5 cm): the anterior transperitoneal (AT) and lateral transperitoneal (LT) approaches. METHODS: 40 patients with a right large adrenal mass >5 cm underwent right adrenalectomy: 20 patients underwent the AT procedure and 20 patients the LT procedure. Preoperative characteristics were similar for both groups: mean tumor size for the AT and LT groups was 6.52 cm (range 5.2-8.5) and 6.59 cm (range 5.4-8.1), respectively. Mean patient's age was 53 years (23-75 in the AT group and 20-77 in the LT group). AT and LT approaches were compared in terms of operative time, intraoperative blood loss, time to first oral intake and postoperative convalescence. RESULTS: No difference was found between two groups in terms of estimated blood (100 ml for the AT group and 105.3 ml for the LT group), time to first oral intake (2.0 days for both groups) and convalescence (3.5 and 3 days, respectively). The mean operative times of the AT and LT procedures were 75.25 and 84.75 min, respectively: this difference was statistically significant at the Student's t test (p = 0.0423). CONCLUSIONS: Both approaches proved to be safe and minimally invasive. We believe that the shorter operative time of AT procedures was related to the better visibility of familiar anatomic landmarks, easier access to the vessels and a larger operative field. For these reasons, we prefer the AT approach in the management of large adrenal masses.

Simplified Indiana pouch with multiple teniamyotomies.

OBJECTIVES: To describe a retrospective review of a single-institution, single-surgeon (M.G.) experience with 44 simplified Indiana pouch with multiple teniamyotomies without detubularization and reconfiguration. METHODS: From April 1999 to May 2003, 44 patients underwent radical cystectomy and continent urinary diversion with a simplified Indiana pouch technique using teniamyotomies without detubularization and reconfiguration. The tenia was sectioned across the whole width and deepened as far as the submucosal layer, with 2 to 3 cm between each teniamyotomy. The efferent tract of the reservoir was prepared using the appendix. If it was unsuitable, an ileum invagination nipple fixed in the ileocecal valve was constructed. RESULTS: The mean follow-up was 3 years (range 1 to 5). Continence was excellent for 40 patients (91%); in 4 patients (9%), daytime incontinence was reported. The urodynamic studies showed an average pressure at 350 mL of capacity of 19.6 cm H2O (range 15.1 to 25.5). The average pressure at maximal capacity (400 to 600 mL) was 32.3 cm H2O (range 28.5 to 35). Long-term complications occurred in 15 patients (34%), with a mean onset of 13.4 months postoperatively. CONCLUSIONS: Our experience showed that a modified Indiana pouch with multiple teniamyotomies has a good capacity with low internal pressure and good continence. Thus, even with the comparable results of other continent pouch models, our modified Indiana pouch is a valid alternative because of its simplicity to perform.

Bladder transitional cell carcinomas: a comparative study of washing and tumor bioptic samples by DNA flow cytometry and FISH analyses.

OBJECTIVE AND METHODS: We compared information obtained from samples of tumor biopsy and bladder washing to evaluate the representatives of the latter type of sampling. Both types of samples from 44 cases of superficial bladder TCCs and one papilloma were analyzed by FCM, to evaluate cellular DNA content, and FISH, to detect numerical aberration of chromosome 9. RESULTS: The use of both tumor and washing samples by FCM and FISH analyses evidenced alterations in 95% of cases. FCM evidenced higher aneuploid frequency in bladder washing than in bioptic specimens. In bladder washing, FISH analysis showed higher frequency of monosomy and lower frequency of trisomy than in biopsy. No correlation was found between histological grade and centromeric chromosome 9 loss while correlation was evidenced with centromeric 9 gain. CONCLUSION: Irrigation specimens, analyzed by FCM and FISH, can complement information obtained by biopsy in cytodiagnosis and follow-up of patients with bladder TCC.