Introduction and Objective:
Carcinoma prostate is considered highly aggressive in Asian countries such as India. This raises an argument whether active surveillance (AS) gives a false sense of security as opposed to upfront radical prostatectomy (RP) in Indian males with low-risk prostate cancer (PCa). We analyzed our prospectively maintained robot-assisted RP (RARP) database to address this question.
Materials and Methods:
Five hundred and sixty-seven men underwent RARP by a single surgical team from September 2013 to September 2019. Of these, 46 (8.1%) were low risk considering the National Comprehensive Cancer Network criteria. Gleason grade group and stage were compared before and after surgery to ascertain the incidence of upgrading and upstaging. Preoperative clinical and pathological characteristics were analyzed for association with the probability of upstaging and upgrading.
Results:
The mean age was 60.8 ± 6.8 years. Average prostate-specific antigen level was 6.7 ± 2.0 ng/mL. 40 (86.9%) patients had a T1 stage disease and 6 (13%) patients were clinically in T2a stage. A total of 25 (54.3%) cases were either upstaged or upgraded, 19 (41.3%) showed no change, and the remaining 2 (4.3%) had no malignancy on the final RP specimen. Upstaging occurred in 8 (17.4%) cases: 5 (10.9%) to pT3a and 3 (6.5%) to pT3b. Upgrading occurred in 23 (50%) cases: 19 (41.3%) to Grade 2; 3 (6.5%) to Grade 3; and 1 (2.2%) to Grade 4.
Conclusions:
There is a 50% likelihood of upstaging or upgrading in Indian males with low-risk PCa eligible for AS. Decision to proceed with AS should be taken carefully.
OBJECTIVES: This study aims to perform the first systematic review of the operative techniques of simultaneous radical nephrectomy with hepatic resection for renal cell carcinoma (RCC) with direct hepatic extension. This will also help to understand the demographics, clinical presentation, prevalent histological subtypes, management, the outcomes and to report a case of collecting duct RCC invading the liver who underwent simultaneous nephrectomy with hepatic resection.
DATA SOURCES: PubMed, EMBASE, and Scopus databases.
STUDY SELECTION: We searched the articles between the years 1991 to 1st April 2021 in the English language. Case reports, case series, and matched cohort studies were included. Eligible studies reported renal mass characteristics with nature of extension, histopathological features, operative manoeuvres, and outcomes.
DATA EXTRACTION: Data were extracted as per Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines.
RESULTS: The initial search strategy yielded 33 results in PubMed, 34 in Scopus, and 81 in EMBASE database, of which six articles were found eligible for review. The mean size of tumour was >10 cm and with a mean age of 51-67 years. All cases had RCC with direct extension to the liver, and all underwent simultaneous nephrectomy with liver resection with a technique of liver hanging manoeuvre used commonly. The most common histological type was clear cell carcinoma. The mean blood loss was 3.3 liters, and the mean hospital stay was 9.75 days.
CONCLUSIONS: A review of the currently available literature shows that the invasion to surrounding structures, including the liver by the RCC is not so common, and it possesses a treatment challenge for the clinician. Currently, en bloc surgical removal with anatomical or non-anatomical resection of the liver is the only modality that provides the best chance of control for the RCC with direct hepatic extension, although a frail patient may not afford this. Adjuvant therapies for RCC with the liver infiltration should be individualised based on histopathology. Collecting duct carcinoma is an aggressive malignancy, early diagnosis and surgical resection with a multidisciplinary approach are indispensable in eligible patients.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.