[show abstract][hide abstract] ABSTRACT: The contact surface area (CSA) of a tumor with adjacent renal parenchyma may determine the complexity and thus the perioperative outcomes of partial nephrectomy (PN).
We devised a novel imaging parameter, renal tumor CSA, and correlate it with perioperative outcomes in patients undergoing PN.
Of 200 patients undergoing PN for a tumor (January 2010 to August 2011), 162 had renal protocol computed tomography scanning data available. CSA was calculated using image-rendering software (Synapse 3D, Fujifilm), and interobserver variability was determined between three independent observers.
CSA was correlated to baseline demographics and perioperative outcomes as a continuous and categorical variable using multivariable logistic regression analysis. The ability of CSA to predict adverse perioperative events was compared with demographic factors and nephrometry scoring systems.
The mean tumor size was 3.1cm; CSA was 18.3 cm(2). CSA ≥20 cm(2) correlated with adverse tumor characteristics (greater tumor size, volume, and complexity) and perioperative outcomes (more parenchymal volume loss, blood loss, and complications) compared with CSA <20 cm(2). On multivariable logistic regression, CSA independently predicted operative time, complications, hospital stay, and renal functional outcomes. This predictive ability of CSA was superior to the other parameters evaluated.
CSA is a novel imaging parameter that quantifies the CSA of renal tumor with adjacent parenchyma. Our preliminary data indicate that CSA correlates with PN outcomes. If validated externally in a larger cohort, CSA could be incorporated into future versions of nephrometry scoring systems.
In this study we outline the method of calculating the contact surface area (CSA) of renal tumors with the surrounding normal kidney using image-rendering software. We found that CSA correlates with a number of important surgical outcomes including operative time, loss of renal function, and complications.
[show abstract][hide abstract] ABSTRACT: Background
The prostate cancer microenvironment profoundly inhibits effector immune-cell activity. We have shown that interleukin (IL) 15, unlike other cytokines proposed for anti-tumour immunotherapy such as IL12 and IL21, can increase natural killer (NK) cell and CD8 T-cell activity within the prostate cancer microenvironment. To investigate mechanisms of this activation, we studied the effects of IL15 on inhibitory and activatory receptors on NK cells and their corresponding ligands on prostate cancer cells. NK receptors known as killer-Ig-like receptors (KIRs) have a crucial role in NK-mediated killing of tumour cells. NK-receptor ligands on tumour cells can attenuate NK activity by binding their corresponding inhibitory receptors. Conversely, increased HLA-related ligand expression can increase the recognition and killing of tumour cells by T cells.
The prostate cancer cell-lines PC3 and LNCaP were incubated with non-adherent peripheral blood mononuclear cells (PBMCs) at effector-to-target ratios of 8:1 and cytokines IL2 or IL15. After 1 week, NK cells in the co-cultures were stained with antibodies to inhibitory KIRs (KIR2DL1, KIR2DL2, KIR3DL1) and activatory KIRs (NKp44, NKG2D, NKp46, DNAM1). Tumour cells in the co-cultures were stained with antibodies to inhibitory NK-receptor ligands HLA-class1-Bw4 and HLA-G, and activatory receptor ligands Nectin-2, and MICA/B. Antibody to HLA-ABC was also used. Staining was followed by flow cytometric analysis. Groups were compared with one-way ANOVA and post-hoc Newman-Keuls (five repeated experiments).
IL15, but not IL2, inhibited expression of KIR2DL1 and KIR3DL1 by up to 50% (p<0·001) on NK cells in PBMC-prostate cancer cell co-cultures. NKG2D was increased up to 40% (p<0·001) in these cells with IL15 but not IL2. On tumour cells, IL15 decreased HLA-Class-1-Bw4 and HLA-G by 60% (p<0·001) and 75% (p<0·001), respectively. No significant effects were seen on the activatory-ligands whereas HLA-ABC expression was increased by over 65% (p<0·001).
One mechanism by which IL15 increases prostate cancer killing by NK cells in PBMC-prosate cancer co-cultures is through upregulating activatory NKG2D and decreasing inhibitory KIR2DL1 and KIR3DL1 receptors. In addition, inhibitory ligands on prostate cancer cells are downregulated, suggesting strong shifts towards NK activation versus inhibition in the co-cultures. Increased HLA-ABC also favours stronger cytotoxic-T-cell recognition.
Heathside Trust, UK Medical Research Council, National Institute for Health Research, Prostate cancer UK. The research was funded and supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London.
The Lancet 02/2014; 383:S47. · 39.06 Impact Factor
[show abstract][hide abstract] ABSTRACT: Purpose: To assess epidemiological characteristics, clinical and pathological patterns of presentation and treatment strategies in a contemporary population with renal masses. Methods: The CROES collected prospective epidemiological, clinical and pathological data on consecutive patients with renal masses treated over a 1-year period in 98 centers worldwide. Preoperative assessment and treatment were performed according to local clinical practice guidelines. Results: From January 2010 to February 2012, 4288 patients (4355 cases, 4815 tumors), were treated for a renal mass. The mean age of the cohort was 61.5 years and the ratio male:female 1.8:1. Caucasians represented 75% of the population and the median BMI was 27. The cohort exhibited a high rate of comorbidity (65.6%), including a 48.5% rate of hypertension; one-third of patients had a combination of two or more comorbidities. One-third of patients (36%) had risk factors for RCC of which smoking and obesity were the most common. Diagnosis was incidental in 67% of cases and 22.2% of cases had CKD stage ≥III at presentation. Median radiological size was 44 mm (range 2-300 mm) and 68% were cT1. Radical nephrectomy and NSS including ablation were performed in 52% and 46% of cases respectively while 3.6% of cases were actively surveyed. Median pathological size was 43 mm (range 2-300 mm) and 63% of the RCCs were pT1. Conclusions: Current patterns of presentation of RMs are consistent with the decreasing trends in age and clinical or pathological size and increasing incidental diagnosis. Patients exhibit a considerable basal comorbidity and presence of risk factors for RCC. Half of the cases are treated by a Nephron Sparing modality with an increase in the penetration of NSS techniques in the contemporary urological practice.
Journal of endourology / Endourological Society 02/2014; · 1.75 Impact Factor
[show abstract][hide abstract] ABSTRACT: Concerns have been raised regarding partial nephrectomy (PN) techniques that do not occlude the main renal artery.
Compare the perioperative outcomes of superselective versus main renal artery control during robotic PN.
A retrospective analysis of 121 consecutive patients undergoing robotic PN using superselective control (group 1, n=58) or main artery clamping (group 2, n=63).
Group 1 underwent tumor-specific devascularization, maintaining ongoing arterial perfusion to the renal remnant at all times. Group 2 underwent main renal artery clamping, creating global renal ischemia.
Perioperative and functional data were evaluated. The Pearson chi-square or Fisher exact and Wilcoxon rank sum tests were used.
All robotic procedures were successful, all surgical margins were negative, and no kidneys were lost. Compared with group 2 tumors, group 1 tumors were larger (3.4 vs 2.6cm, p=0.004), more commonly hilar (24% vs 6%, p=0.009), and more complex (PADUA 10 vs 8, p=0.009). Group 1 patients had longer median operative time (p<0.001) and transfusion rates (24% vs 6%, p<0.01) but similar estimated blood loss (200 vs 150ml), perioperative complications (15% vs 13%), and hospital stay. Group 1 patients had less decrease in estimated glomerular filtration rate at discharge (0% vs 11%, p=0.01) and at last follow-up (11% vs 17%, p=0.03). On computed tomography volumetrics, group 1 patients trended toward greater parenchymal preservation (95% vs 90%, p=0.07) despite larger tumor size and volume (19 vs 8ml, p=0.002). Main limitations are the retrospective study design, small cohort, and short follow-up.
Robotic PN with superselective vascular control enables tumor excision without any global renal ischemia. Blood loss, complications, and positive margin rates were low and similar to main artery clamping. In this initial developmental phase, limitations included more perioperative transfusions and longer operative time. The advantage of superselective clamping for better renal function preservation requires validation by prospective randomized studies.
Preserving global blood flow to the kidney during robotic partial nephrectomy (PN) does not lead to a higher complication rate and may lead to better postoperative renal function compared with clamped PN techniques.
[show abstract][hide abstract] ABSTRACT: To facilitate robotic nerve-sparing radical prostatectomy, we developed a novel three dimensional (3D) surgical navigation model which is displayed on the Tile-Pro function of the da Vinci® surgeon console. Based on 3-D trans-rectal ultrasound (TRUS)-guided prostate biopsies (Urostation®, Koelis), we reconstructed a 3-D model of the TRUS-visible, histologically-confirmed 'index' cancer lesion in 10 consecutive patients. Five key anatomic structures (prostate, image-visible biopsy-proven 'index' cancer lesion, neurovascular bundles, urethra, and recorded biopsy trajectories) were image-fused and displayed onto the Tile-Pro function of the robotic console. 3D model facilitated careful surgical dissection in the vicinity of the biopsy-proven 'index' lesion. Geographic location of the 'index lesion' on final histology correlated with the software-created 3D model. Negative surgical margins were achieved in 90%, except for one case with extensive extra-prostate extension. At post-operative 3 months, PSA were undetectable (<0.03 ng/ml) in all cases. The initial experience of the navigation model is presented.
Journal of endourology / Endourological Society 01/2014; · 1.75 Impact Factor
[show abstract][hide abstract] ABSTRACT: Kidney cancer is associated with renal vein or inferior vena cava (IVC) thrombus in up to 10% of cases. The management of these cases is complex, and thus typically performed open surgically. At selected institutions, the robotic approach is being explored. We review the literature on robotic IVC surgery.
Over the past 15 years, minimally invasive thrombectomy has been reported in 78 patients in the literature, including level I (67%), level II (30%) and level III (3%) thrombi. Of these, 91% involved hand-assisted or straight laparoscopic surgery, occasionally combined with open surgery for the IVC control aspect of the procedure. Only nine robotic cases have been reported in the literature to date, including level I (n = 4) and high level thrombi. Additionally, we are developing novel strategies to advance robotic surgery for level II and level III thrombi.
Robotic surgery for selected level I and II caval thrombi is feasible. Further, clinical experience is necessary to determine the appropriate place of robotic surgery in managing these complex patients with caval involvement.
Current opinion in urology 01/2014; · 2.50 Impact Factor
[show abstract][hide abstract] ABSTRACT: Intraoperative transrectal ultrasonography during laparoscopic radical prostatectomy has been reported to lead to a reduction in surgical margin rates. However, the use of a surgeon-controlled ultrasound probe that allows for precise manipulation and direct interpretation of the image by a console surgeon has yet to be studied. The aim of the present study was to show initial feasibility using the microtransducer with 9-mm scan length controlled by the console surgeon during robot-assisted radical prostatectomy in 10 patients. The transducer is designed as a drop-in probe with a flexible cord for insertion through a laparoscopic port, and is controlled by a robotic arm with the ultrasonographic image shown as a console Tile-pro display. Intraoperative localization of the biopsy-proven cancerous hypoechoic lesion was feasible in four out of four cases. The microtransducer facilitated identification of the bladder neck as well as the appropriate level of neurovascular bundle release. Negative surgical margin was achieved in all 10 cases (100%), even though five of 10 patients (50%) had extraprostatic (pT3) disease. Recovery of erectile function and continence was encouraging. In conclusion, intraoperative ultrasound navigation using a drop-type microtransducer is a novel technique that could enhance the incremental value of the standard information.
International Journal of Urology 01/2014; · 1.73 Impact Factor
[show abstract][hide abstract] ABSTRACT: Focal therapy has been introduced for the treatment of localised prostate cancer (PCa). To provide the necessary data for consistent assessment, all focal therapy trials should be performed according to uniform, systematic pre- and post-treatment evaluation with well-defined end points and strict inclusion and exclusion criteria.
To obtain consensus on trial design for focal therapy in PCa.
A four-staged consensus project based on a modified Delphi process was conducted in which 48 experts in focal therapy of PCa participated. According to this formal consensus-building method, participants were asked to fill out an iterative sequence of questionnaires to collect data on trial design. Subsequently, a consensus meeting was held in which 13 panellists discussed acquired data, clarified the results, and defined the conclusions.
A multidisciplinary board from oncologic centres worldwide reached consensus on patient selection, pretreatment assessment, evaluation of outcome, and follow-up.
Inclusion criteria for candidates in focal therapy trials are patients with prostate-specific antigen <15 ng/ml, clinical stage T1c-T2a, Gleason score 3+3 or 3+4, life expectancy of >10 yr, and any prostate volume. The optimal biopsy strategy includes transrectal ultrasound-guided biopsies to be taken between 6 mo and 12 mo after treatment. The primary objective should be focal ablation of clinically significant disease with negative biopsies at 12 mo after treatment as the primary end point.
This consensus report provides a standard for designing a feasible focal therapy trial.
A variety of ablative technologies have been introduced and applied in a focal manner for the treatment of prostate cancer (PCa). In this consensus report, an international panel of experts in the field of PCa determined pre- and post-treatment work-up for focal therapy research.
[show abstract][hide abstract] ABSTRACT: Current treatment options for prostate cancer, other than active surveillance, are limited to entire prostate gland destruction through removal (radical prostatectomy), radiation (external beam, brachytherapy, or a combination of both), or thermal ablation (cryoablation, high-intensity focused ultrasound, or radiofrequency). There has been a demand to develop ablative therapies that attempt to reduce treatment burden while retaining cancer control and avoiding the psychological morbidity associated with surveillance.
We reviewed the literature to concentrate on the practical aspects of focal therapy for Pca with the following key words: photodynamic therapy, HIFU, cryotherapy, focal laser ablation, electroporation, radiofrequency, external beam radiation, organ-sparing approach, focal therapy, prostate cancer. The aim of this article is to review these energy modalities' functional and oncologic results.
Prostatic tumor ablation can be achieved with different energies: freezing effect for cryotherapy, thermal effect using focalized ultrasound for HIFU and using thermal effect of light for FLA and activation of a photosensitizer by light for PDT, among others. Radiofrequency and microwave therapy have been tested in this field and demonstrated their usefulness. Electroporation is currently being developed on preclinical models. External beam radiation with microboost on neoplastic foci is under evaluation. HIFU and cryotherapy require the use of sophisticated and expensive machines. However, series published short term effective with low morbity, reversible therapy.
Several energy modalities are being developed to achieve the trifecta of continence, potency, and oncologic efficiency. Comparison of the different focal approaches is complex owing to important heterogeneity of the trials. In the future, it seems likely that each technique will have its own selective indications.
[show abstract][hide abstract] ABSTRACT: Despite significant developments in transurethral surgery for benign prostatic hyperplasia (BPH), simple prostatectomy remains an excellent option for patients with large glands.
To describe our technique of transvesical robotic simple prostatectomy (RSP).
From May 2011 to April 2013, 25 patients underwent RSP.
We performed RSP using our technique.
Baseline demographics, pathology data, perioperative complications, 90-d complications, and functional outcomes were assessed.
Mean patient age was 72.9 yr (range: 54-88), baseline International Prostate Symptom Score (IPSS) was 23.9 (range: 9-35), prostate volume was 149.6ml (range: 91-260), postvoid residual (PVR) was 208.1ml (range: 72-800), maximum flow rate (Qmax) was 11.3ml/s, and preoperative prostate-specific antigen was 9.4 ng/ml (range: 1.9-56.3). Eight patients were catheter dependent before surgery. Mean operative time was 214min (range: 165-345), estimated blood loss was 143ml (range: 50-350), and the hospital stay was 4 d (range: 2-8). There were no intraoperative complications and no conversions to open surgery. Five patients had a concomitant robotic procedure performed. Early functional outcomes demonstrated significant improvement from baseline with an 85% reduction in mean IPSS (p<0.0001), an 82.2% reduction in mean PVR (p=0.014), and a 77% increase in mean Qmax (p=0.20). This study is limited by small sample size and short follow-up period. One patient had a urinary tract infection; two had recurrent hematuria, one requiring transfusion; one patient had clot retention and extravasation, requiring reoperation.
Our technique of RSP is safe and effective. Good functional outcomes suggest it is a viable option for BPH and larger glands and can be used for patients requiring concomitant procedures.
We describe the technique and report the initial results of a series of cases of transvesical robotic simple prostatectomy. The procedure is both feasible and safe and a good option for benign prostatic hyperplasia with larger glands.
[show abstract][hide abstract] ABSTRACT: To evaluate robotic dry lab exercises for their face, content, construct, and concurrent validities. Also to evaluate the applicability of the Global Evaluative Assessment of Robotic Skills (GEARS) tool to assess dry lab performance.
Participants were prospectively categorized into two groups: robotic novice (no cases as primary surgeon) and expert (≥30 cases). Participants completed three virtual realtiy (VR) exercises using the da Vinci Skills Simulator as well as corresponding dry lab versions of each exercise (Mimic Technologies) on the da Vinci Surgical System. Simulator performance was assessed by metrics measured on the simulator. Dry lab performance was blindly video-evaluated by expert review using the six-metric GEARS tool. Participants completed a post-study questionnaire (face and content validity). Wilcoxon nonparametric test compared performance between groups (construct validity). Spearman's correlation coefficient assessed simulation to dry lab performance (concurrent validity).
Mean robotic case experience for novices was zero and 200 (range 30-2000) for experts. Expert surgeons found the dry lab exercises both "realistic" (median score 8/10 (range 4-10)) and "very useful" for training of residents (median score 9/10 (range 5-10)). Overall, expert surgeons completed all dry lab tasks more efficiently (p<0.001) and effectively (GEARS total score p<0.001) compared to novices. Moreover, experts outperformed novices in each individual GEARS metric (p<0.001). Finally, in comparing dry lab to simulator performance, there was a moderate correlation overall (r=0.54, p<0.001). Most simulator metrics correlated moderately to strongly with corresponding GEARS metrics (r= 0.54, p=0.0003).
Featured robotic dry lab exercises have face, content, construct, and concurrent validity with the corresponding VR tasks. Additionally, until now, assessment of dry lab exercises has been limited to basic metrics (i.e., time to completion, error). For the first time, we demonstrate the feasibility of applying a global assessment tool (GEARS) to dry lab training.
[show abstract][hide abstract] ABSTRACT: ● To analyze the long term outcome of lymph node (LN) positive bladder cancer patients following radical cystectomy (RC) and extended pelvic lymph node dissection (ePLND) who did not receive any adjuvant therapy PATIENTS AND METHODS: ● Retrospective, combined cohort analysis based on the two prospectively maintained cystectomy databases from the University of Southern California and the University of Bern ● Eligible patients underwent RC with ePLND for cN0M0 disease but turned out to be LN-positive ● None had neo-adjuvant therapy, all negative surgical margins ● Kaplan-Meier plots were used to estimate recurrence-free (RFS) and overall survival (OS), subgroup comparisons were performed with Log-rank tests, and multivariable analysis based on Cox proportional hazard models RESULTS: ● Of 521 LN-positive patients, 251 (48%) never received adjuvant therapy ● While pathological stage distribution was comparable, they were older and had both fewer total and positive LNs identified compared to those who underwent adjuvant therapy ● Median RFS for patients with surgery alone was 1.6y ● Recurrences mainly occurred within 2 years following RC resulting in 5- and 10-year RFS rates of 32% and 26%, respectively ● Pathological T-stage, total number of LNs and number of positive LNs identified were independent predictors of survival for RFS and OS CONCLUSIONS: ● 25% of patients with documented LN metastases not receiving adjuvant therapy were cured with RC and ePLND ● However, a few relapses may occur also later than three years ● redictors of survival are pathological T-stage, number of total LNs, and number of positive LNs identified.
[show abstract][hide abstract] ABSTRACT: PURPOSE:
We quantified prostate swelling and the intraprostatic point shift during high intensity focused ultrasound using real-time ultrasound.
MATERIALS AND METHODS:
The institutional review board approved this retrospective study. Whole gland high intensity focused ultrasound was done in 44 patients with clinically localized prostate cancer. Three high intensity focused ultrasound sessions were required to cover the entire prostate, including the anterior zone (session 1), middle zone (session 2) and posterior zone (session 3). Computer assisted 3-dimensional reconstructions based on 3 mm step-section images of intraoperative transrectal ultrasound were compared before and after each session.
Most prostate swelling and intraprostatic point shifts occurred during session 1. The median percent volume increase was 18% for the transition zone, 9% for the peripheral zone and 13% for the entire prostate. The volume percent increase in the transition zone (p <0.001), peripheral zone (p = 0.001) and entire prostate (p = 0.001) statistically depended on the volume of each area measured preoperatively. The median 3-dimensional intraprostatic shift was 3.7 mm (range 0.9 to 13) in the transition zone and 5.5 mm (range 0.2 to 14) in the peripheral zone. A significant negative linear correlation was found between the preoperative presumed circle area ratio, and the percent increase in prostate volume (p = 0.001) and shift (p = 0.01) during high intensity focused ultrasound.
We quantified significant prostate swelling and shift during high intensity focused ultrasound. Smaller prostates and a smaller preoperative presumed circle area ratio were associated with greater prostate swelling and intraprostatic shifts. Real-time intraoperative adjustment of the treatment plan impacts the achievement of precise targeting during high intensity focused ultrasound, especially in prostates with a smaller volume and/or a smaller preoperative presumed circle area ratio.
The Journal of urology 10/2013; 190(4):1224-32. · 4.02 Impact Factor
[show abstract][hide abstract] ABSTRACT: We developed and assessed a technique of: (i) expanding Denonvilliers' space by hydrogel (polyethylene glycol) during focal cryoabation; and (ii) temperature mapping to ensure protection of the rectal wall. In a fresh cadaver, 20 cc of hydrogel was injected transperineally into Denonvilliers' space under transrectal ultrasound guidance. Successful expansion of Denonvilliers' space was achieved with a range of 9-11 mm thickness covering the entire posterior prostate surface. Two freeze-thaw cycles were used to expand the iceball reaching the rectal wall as an end-point. Intraoperative transrectal ultrasound monitoring and temperature mapping in Denonvilliers' space by multiple thermocouples documented real-time iceball expansion up to 10 mm beyond the prostate, and safety in protecting the rectal wall from thermal injury. The lowest temperatures of the thermocouples with a distance of 0 mm, 5 mm and 10 mm from the prostate were: -35°C, -18°C and 0°C (P < 0.001), respectively. In gross and microscopic examination, the hydrogel mass measured 11 × 40 × 34 mm, which was identical to the intraoperative transrectal ultrasound measurements, there was no infiltration of the hydrogel into the rectal wall or prostate and no injury to the pelvic organs. In conclusion, the expansion of Denonvilliers' space by transperineal injection of hydrogel is feasible and a promising technique to facilitate energy-based focal therapy of prostate cancer.
International Journal of Urology 10/2013; · 1.73 Impact Factor
[show abstract][hide abstract] ABSTRACT: Extended oncologic outcomes after minimally invasive cystectomy have not been previously reported.
To report outcomes of robot-assisted radical cystectomy (RARC) and laparoscopic radical cystectomy (LRC) for bladder cancer (BCa) at up to 12-yr follow-up.
All 121 patients undergoing RARC or LRC for BCa between December 1999 and September 2008 at a tertiary referral center were retrospectively evaluated from a prospectively maintained database.
RARC or LRC.
Primary end points were overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) calculated using Kaplan-Meier curves. Secondary end points were survival analysis by number of lymph nodes (LNs) and type of procedure. Surgical outcomes, including complications, were analyzed.
Most tumors were muscle invasive (≥pT2; n=81; 67%) urothelial carcinomas (n=102; 84%). Extended LN dissection was performed in 98 patients (81%), with a median of 14 nodes removed (interquartile range [IQR]: 8-18). Twenty-four patients (20%) had node-positive disease (N1: 10 [8%]; N2: 14 [12%]). Eight patients (6.6%) had positive soft tissue margins. Median follow-up was 5.5 yr (mean: 5.9; IQR: 4.2-8.2; range: 0.13-12.1). At last follow-up, 58 patients (48%) had no evidence of disease, 3 (2%) were alive with recurrence, 59 (49%) had died, and status was unknown in 1. Twenty-eight patients (23%) died from cancer-specific causes, 20 (17%) from unrelated causes, and 11 (9%) from unknown causes. The 10-yr actuarial OS, CSS, and RFS rates were 35%, 63%, and 54%, respectively. At last follow-up, OS for pT0, pTis/a, pT1, pT2, and pT3 versus pT4 was 67%, 73%, 53%, 50%, and 16% versus 0%, respectively (p=0.02). At last follow-up, CSS for pT0, pTis/a, pT1, pT2, and pT3 versus pT4 was 100%, 91%, 74%, 77%, and 56% versus 0%, respectively (p=0.03).
The longest oncologic outcomes following RARC and LRC for BCa reported demonstrates results similar to those reported for open RC. Continued analysis and direct randomized comparison between techniques is necessary.
[show abstract][hide abstract] ABSTRACT: Molecular imaging (MI) entails the visualisation, characterisation, and measurement of biologic processes at the molecular and cellular levels in humans and other living systems. Translating this technology to interventions in real-time enables interventional MI/image-guided surgery, for example, by providing better detection of tumours and their dimensions.
To summarise and critically analyse the available evidence on image-guided surgery for genitourinary (GU) oncologic diseases.
A comprehensive literature review was performed using PubMed and the Thomson Reuters Web of Science. In the free-text protocol, the following terms were applied: molecular imaging, genitourinary oncologic surgery, surgical navigation, image-guided surgery, and augmented reality. Review articles, editorials, commentaries, and letters to the editor were included if deemed to contain relevant information. We selected 79 articles according to the search strategy based on the Preferred Reporting Items for Systematic Reviews and Meta-analysis criteria and the IDEAL method.
MI techniques included optical imaging and fluorescent techniques, the augmented reality (AR) navigation system, magnetic resonance imaging spectroscopy, positron emission tomography, and single-photon emission computed tomography. Experimental studies on the AR navigation system were restricted to the detection and therapy of adrenal and renal malignancies and in the relatively infrequent cases of prostate cancer, whereas fluorescence techniques and optical imaging presented a wide application of intraoperative GU oncologic surgery. In most cases, image-guided surgery was shown to improve the surgical resectability of tumours.
Based on the evidence to date, image-guided surgery has promise in the near future for multiple GU malignancies. Further optimisation of targeted imaging agents, along with the integration of imaging modalities, is necessary to further enhance intraoperative GU oncologic surgery.