Kim SH, et al. Investig Clin Urol. 2016 Jan;57(1):63-72. https://doi.org/10.4111/icu.2016.57.1.63

Keywords: Printing; Three-Dimensional; Kidney Neoplasms; Nephrectomy

To compare the oncological and perioperative outcomes of different nephroureterectomy approaches in patients with non-metastatic upper tract urothelial carcinoma (UTUC). We retrospectively analyzed the data of 422 patients who underwent open, laparoscopic, or robotic nephroureterectomy for non-metastatic UTUC. Perioperative and postoperative survival outcomes were compared using Kaplan-Meier analyses and Cox-proportional hazard models. Of the patients, 161, 137, and 124 were treated with an open, laparoscopic, and robotic approach, respectively. Laparoscopic and robotic approaches involved significantly less blood loss (p = 0.001), shorter hospital stay (p < 0.001), and longer operation time (p < 0.001) compared with the open approach. There were no significant differences in intraoperative complications (open, 8.1%; laparoscopic, 5.1%; robotic, 7.3%; p = 0.363) or early postoperative complications (open, 14.9%; laparoscopic, 14.6%; robotic, 13.7%; p = 0.880). The laparoscopic and robotic groups showed significantly less postoperative analgesic use (p = 0.015). The robotic group showed significantly longer progression-free, cancer-specific, and overall survivals than the open approach group on univariate Kaplan-Meier analysis, but surgery type was not significantly associated with survival outcomes per multivariate Cox proportional tests (all p-values > 0.05). The laparoscopic and robotic approaches yielded better perioperative outcomes, such as less intraoperative bleeding, shorter hospital stays, less analgesic usage, and non-inferior oncological outcomes, compared with the open approach. Further prospective studies are needed to compare these surgical techniques.

Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? While laparoscopic radical nephrectomy (LRN) has been confirmed in various studies to be at least as efficacious as open radical nephrectomy (ORN) in terms of oncological control and more advantageous from the perspective of minimal invasiveness, very few studies have examined its feasibility and efficacy when applied to renal masses exceeding 7 cm in size, and even fewer involved results obtained from multicentre investigations. The present study retrospectively reviewed the outcome of LRN for masses exceeding 7 cm in size carried out in 26 institutions between 2000 and 2007 and concluded that LRN offers results comparable to ORN in terms of both tumour control and procedure‐associated morbidities. Furthermore, details from the study suggest that while the size of renal mass that can be treated using LRN may not be a necessarily limiting factor, the experience of the laparoscopic surgeon is a primary determinant in the overall outcome. OBJECTIVE: To assess the feasibility and oncologic efficacy of laparoscopic radical nephrectomy (LRN) compared with open radical nephrectomy (ORN) in patients with large renal cell carcinomas (RCCs) >7 cm in size. PATIENTS AND METHODS: We analysed the data from 255 patients who underwent radical nephrectomies at 26 institutions in Korea between January 2000 and December 2007 for RCCs > 7 cm in size. Eighty‐eight patients who underwent LRNs were compared with 167 patients who underwent ORNs. The patients with tumor thrombi in the renal vein or IVC, and lymph node or distant metastases were excluded. We compared the operative time, estimated blood loss, complication rates, and 2‐year overall and disease‐free survival rates between the LRN and ORN groups. RESULTS: The median duration of postoperative follow‐up was 19 months for the LRN group and 25.8 months for the ORN group. The operative time was significantly longer in the LRN group than in the ORN group (241.5 ± 74.8 min vs 202.7 ± 69.6 min, P < 0.001) and blood loss was significantly lower in the LRN group than in the ORN group (439.8 ± 326.8 mL vs 604.4 ± 531.4 mL, P = 0.006). No statistically significant difference was found in complication rates, the 2‐year overall (92.7% vs 94%, P = 0.586) and disease‐specific (90.1% vs 93.7%, P = 0.314) survival rates between the LRN and ORN groups. CONCLUSIONS: Despite the longer operative time, LRN was an effective and less invasive treatment option for clinical T2 renal tumors. It achieved a degree of cancer control similar to that obtained with ORN.

We examined the synergistic antitumor effects of cisplatin combined with triptolide in cisplatin resistant T24R2 bladder cancer cells and investigated possible molecular mechanisms. T24R2 cells were treated with cisplatin and/or triptolide. Tumor cell proliferation was determined using cell counting and clonogenic assays. The combination index of the synergism between cisplatin and triptolide was calculated. The cell cycle phase and apoptosis rate were determined by flow cytometry. Apoptosis and cell cycle related protein expression were analyzed by Western blot. The synergistic cytotoxicity effect of cisplatin and triptolide combination treatment was greater than the cytotoxic effect of cisplatin or triptolide alone. Combination treatment also induced cell cycle arrest via cyclin D1 and E1 expression. Apoptosis induced by combination treatment was accompanied by increased expression of caspase-3, 8 and 9, PARP and cytochrome c. Our results suggest that triptolide synergistically enhanced the antitumor effect of cisplatin in cisplatin resistant human bladder cancer cells. Cisplatin and triptolide combination treatment may be effective for advanced bladder cancer.