Bladder mapping of tumour recurrence after radical nephroureterectomy for upper tract urothelial carcinoma and its influence on oncological outcomes.

OBJECTIVES: To assess the location of intravesical recurrence (IVR) after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC), to determine the main predictive factors for IVR in the bladder-cuff area (BCA), and to assess the effect of BCA recurrence (BCAR) on prognosis. PATIENTS AND METHODS: This was a multicentre, retrospective study using the French collaborative database on UTUC, which includes data for all patients treated in 24 referral uro-oncology centres across the country. All patients who underwent RNU with bladder-cuff excision and who developed IVR between 1995 and 2010 were selected. Patients were divided into two groups: Group A: BCAR; and Group B: recurrence elsewhere in the bladder. The Kaplan-Meier method was used to estimate the probability of BCAR-free survival. Groups were compared using the log-rank test. Independent risk factors for BCAR were identified using a Cox proportional hazard regression model, with univariate and multivariate analyses. RESULTS: Overall, 163 patients were included in the final analysis: Group A, 87 patients (53.4%) and Group B, 76 (46.6%). The clinicopathological characteristics were similar in the groups. The median (interquartile range [IQR]) follow-up was 36 (31.7-40.39) months. The median (IQR) time to IVR was 10.0 (8.6-13.39) months [Group A: 11.0 (8.8-13.2)  months vs Group B: 10.0 (8.5-11.5) months; P = 0.35]. The probability of BCAR at 1, 2, and 3 years was 45.5% (95% confidence interval [CI] 40.1-50.9), 17.9% (95% CI 13.7-22.1), and 10.8% (95% CI 7.4-14.2) respectively, whereas the probability of recurrence elsewhere in the bladder was 42.1% (95% CI 36.4-47.8), 14.7% (95% CI 10.6-18.8), and 4.4% (95% CI 1.9-6.9), respectively (P = 0.35). Pathological tumour stage (≥pT3) was significantly related to the risk of BCAR (P = 0.03). CONCLUSION: There were more BCARs after RNU in advanced UTUC. However, no preferred site for recurrence was detected.

Impact of ischaemia time on renal function after partial nephrectomy: a systematic review.

OBJECTIVE: To assess the impact of ischaemia on renal function after partial nephrectomy (PN). MATERIALS AND METHODS: A literature review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. In January 2015, the Medline and Embase databases were systematically searched using the protocol ('warm ischemia'[mesh] OR 'warm ischemia'[ti]) AND ('nephrectomy'[mesh] OR 'partial nephrectomy'[ti]). An updated search was performed in December 2015. Only studies based on a solitary kidney model or on a two-kidney model but with assessment of split renal function were included in this review. RESULTS: Of the 1119 studies identified, 969 abstracts were screened after duplicates were removed: 29 articles were finally included in this review, including nine studies that focused on patients with a solitary kidney. None of the nine studies adjusting for the amount of preserved parenchyma found a negative impact of warm ischaemia time on postoperative renal function, unless this was extended beyond a 25-min threshold. The quality and the quantity of preserved parenchyma appeared to be the main contributors to postoperative renal function. CONCLUSION: Currently, no evidence supports that limited ischaemia time (i.e. ≤25 min) has a higher risk of reducing renal function after PN compared to a 'zero ischaemia' technique. Several recent studies have suggested that prolonged warm ischaemia (>25-30 min) could cause an irreversible ischaemic insult to the surgically treated kidney.

Current perspectives of sentinel lymph node dissection at the time of radical surgery for prostate cancer.

The sentinel lymph node dissection (SLND) concept relies on the accurate detection of primary nodal landing sites and could represent a major advancement towards accurate, non-invasive pelvic staging in prostate cancer (PCa). Different iterations of the technique have now been validated and reproduced mostly in large-volume centres. The existing evidence denotes the feasibility and sensitivity of SLND, with encouraging pre- and intraoperative detection rates of 98% and 96%. Yet, current surgical practice mandates a backup template dissection due to a false negative rate, up to 7.1%, of tracer-guided surgery. In practice, SLND failed to achieve nodal detection in up to 20% of pelvic sidewalls. Despite scarce validated evidence, current consensus mainly attributes these false negative cases to altered prostatic drainage secondary to malignant obliteration of lymphovascular structures. In parallel, multiple SLND studies have highlighted the complex and variable drainage pathways from the prostate, furthering the established anatomical atlases. The most promising approach may therefore rely in magnetic nanoparticles and PCa-targeting ligands. However, in the absence of a clear sentinel node or region for the prostate, formal SLND is difficult to integrate in routine surgical practice for now. As such, tracer-guided dissection is only used as a complementary intervention to highlight first- echelon nodes and aberrant lymphatic pathways found beyond the commonly adopted pelvic lymphadenectomy templates.