A snapshot of nephron-sparing surgery in Italy: a prospective, multicenter report on clinical and perioperative outcomes (the RECORd 1 project).

INTRODUCTION: Nephron-sparing surgery (NSS) has become the standard of care for the surgical management of small and clinically localized renal cell carcinoma (RCC). The conservative management of those RCCs is increasing over time. Aim of this study was to report a snapshot of the clinical, perioperative and oncological results after NSS for RCC in Italy. MATERIAL AND METHODS: We evaluated all patients who underwent conservative surgical treatment for renal tumours between January 2009 and December 2012 at 19 urological Italian Centers (RECORd project). Perioperative, radiological and histopathological data were recorded. Surgical eras (2009 vs 2012 and year periods 2009-2010 vs 2011-2012) were compared. RESULTS: Globally, 983 patients were evaluated. More recently, patients undergoing NSS were found to be significantly younger (p = 0.05) than those surgically treated in the first study period, with a significantly higher rate of NSS with relative and imperative indication (p < 0.001). More recently, a higher percentage of procedures for cT1b or cT2 renal tumours was observed (p = 0.02). Utilization rate of open partial nephrectomy (OPN) constantly decreased during years, laparoscopic partial nephrectomy (LPN) remained almost constant while robot-assisted partial nephrectomy (RAPN) increased. The rate of clampless NSS constantly increased over time. The use of at least one haemostatic agent has been significantly more adopted in the most recent surgical era (p < 0.001). CONCLUSIONS: The utilization rate of NSS in Italy is increasing, even in elective and more complex cases. RAPN has been progressively adopted, as well as the intraoperative utilization of haemostatic agents and the rate of clampless procedures.

Case report: Successful IVF programme after conservatively treated endometrial cancer.

Some cases of successful pregnancy after conservative endometrial cancer management have been reported. This paper presents such a case, an infertile patient with conservatively treated endometrial cancer (stage 1a grade 1) who conceived and carried a successful pregnancy after IVF treatment. The conservative treatment consisted of hysteroscopic biopsies and oral megestrol acetate 600 mg daily for 3 months. At the end of the treatment the endometrial cancer remitted to simple endometrial hyperplasia. IVF was performed immediately and 32 days after embryo transfer an intrauterine single gestational sac with fetal pole and heartbeat was detected by transvaginal ultrasound. The woman received routine obstetric care and a caesarean section was performed at 38 weeks of gestation. The histological evaluation after delivery showed no evidence of recurrent disease. Twenty-six months after the delivery, the woman is healthy and free of the disease. It is concluded that conservative treatment of stage 1a and grade 1 endometrial adenocarcinoma is an available option in young women who wish to preserve their fertility.