OGon behalf of the European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group
on behalf of the European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group
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Although the vast majority of prostate-specific membrane antigen (PSMA) positron emission tomography (PET) imaging occurs in the field of prostate cancer, PSMA is also highly expressed on the cell surface of the microvasculature of several other solid tumors, including renal cell carcinoma (RCC). This makes it a potentially interesting imaging target for the staging and monitoring of RCC. The objective of this review is to provide an overview of the current evidence regarding the use of PSMA PET/Computed Tomography in RCC patients.
4 October 2022 in European Journal of Surgical Oncology
Renal cell carcinoma (RCC) is characterized by its diverse histopathological features, which pose possible challenges to accurate diagnosis and prognosis. A comprehensive literature review was conducted to explore recent advancements in the field of artificial intelligence (AI) in RCC pathology. The aim of this paper is to assess whether these advancements hold promise in improving the precision, efficiency, and objectivity of histopathological analysis for RCC, while also reducing costs and interobserver variability and potentially alleviating the labor and time burden experienced by pathologists. The reviewed AI-powered approaches demonstrate effective identification and classification abilities regarding several histopathological features associated with RCC, facilitating accurate diagnosis, grading, and prognosis prediction and enabling precise and reliable assessments. Nevertheless, implementing AI in renal cell carcinoma generates challenges concerning standardization, generalizability, benchmarking performance, and integration of data into clinical workflows. Developing methodologies that enable pathologists to interpret AI decisions accurately is imperative. Moreover, establishing more robust and standardized validation workflows is crucial to instill confidence in AI-powered systems’ outcomes. These efforts are vital for advancing current state-of-the-art practices and enhancing patient care in the future.
Single-port (SP) robotic surgery is a novel technology and is at the beginning of its adoption curve in urology. The goal of this narrative review is to provide an overview of SP-robotic partial nephrectomy (PN) 4 years after the introduction of the da Vinci SP dedicated platform, focusing on perioperative outcomes, length of stay, and surgical technique. A nonsystematic review of the literature was conducted. The research included the most updated articles that referred to SP robotic PN. Since its commercial release in 2018, several institutions have reproduced robotic PN by using the SP platform, both via a transperitoneal and a retroperitoneal approach. The published SP-robotic PN series are generally based on preliminary experiences by surgeons who had previous experience with conventional multi-arms robotic platforms. The reported outcomes are encouraging. Overall, three studies reported that SP-robotic PN cases had nonsignificantly different operative time, estimated blood loss, overall complications rate, and length of stay compared to the conventional ‘multi-arms’ robotic PN. However, in all these series, renal masses treated by SP had overall lower complexity. Moreover, two studies underlined decreased postoperative pain as a major pro of adopting the SP system. This should reduce/avoid the need for opioids after surgery. No study compared SP-robotic versus multi-arms robotic PN in cost-effectiveness. Published experience with SP-robotic PN has reported the feasibility and safety of the approach. Preliminary results are encouraging and at least noninferior with respect to those from the multi-arms series. Prospective comparative studies with long-term oncologic and functional results are awaited to draw more definitive conclusions and better establish the more appropriate indications of SP robotics in the field of PN.
Renal cell carcinoma (RCC) is the most common form of kidney cancer with 403,262 diagnoses and 170,000 deaths worldwide in 2018. Although partial or radical nephrectomy can be considered a successful treatment in early-stage or localized RCC, in advanced-stage disease, there is a high risk of metastasis or recurrence with a significantly poorer prognosis. Metastatic RCC is generally resistant to both chemotherapy and radiotherapy, and, despite several novel therapeutic agents, disease progression and mortality rates remain high. It is necessary to identify new diagnostic and therapeutic strategies for the management of this cancer. Knowledge of microRNA (miRNA) has consistently increased in the last year. miRNAs play an important role in several biological processes, such as cell proliferation, differentiation, and cell death. Due to this, miRNAs have been identified as an important key in different diseases, especially in cancer, and several studies show miRNAs as attractive tools and targets for novel therapeutic approaches. Recently several miRNAs (including miR-22, miR-203, miR-301 and miR-193a-3p) have been linked to dysregulated molecular pathways involved with the proliferation of cancerous cells and resistance to therapeutic agents. In the present study, recent data from studies assessing the application of miRNAs as biomarkers, therapeutic targets, or modulators of response to treatment modalities in RCC patients are analyzed.
Background: To report a single-center experience with robot-assisted ureteral reimplantation (RAUR) and to compare its outcomes with those of open ureteral reimplantation (OUR). Materials and methods: Patients who underwent RAUR or OUR for ureteral disease between 2016 and 2020 were identified. Data collected included baseline, pathological, perioperative and postoperative features. The RAUR outcomes were compared with those of OUR. Results: Overall, twenty-one (42.8%) patients underwent RAUR, and 28 (57.2%) underwent OUR. The two groups were similar in terms of baseline and pathological characteristics. There was a statistically significant difference in favor of RAUR for median operative time (216 vs. 317min, p=0.01) and median blood loss (35 vs. 175ml, p=0.001). No difference was observed in overall complication rate (33.3 vs. 46.4%, p=0.9), as well as major complications (Clavien-Dindo≥III grade) rate between RAUR and OUR groups. Median LOS was shorter for RAUR (2 vs. 6 days; p=0.001), as well as median catheterization time (16 vs. 28 days; p=0.005). Conclusions: RAUR is a safe and effective minimally invasive surgical procedure for the management of mid to distal ureteral strictures. It can recapitulate the success rate of the gold standard OUR while offering a benefit in terms of lower surgical morbidity and faster postoperative recovery.