RÉSUMÉ
Objective:To explore the technical focus of robotic-assisted laparoscopic surgery for the treatment of horseshoe kidney combined with renal tumor.Methods:The clinical data of a patient with horseshoe kidney combined with renal tumor treated by robot-assisted laparoscopic partial nephrectomy in the Second Hospital of Dalian Medical University in September 2021 were retrospectively analyzed. PubMed, CNKI, Wanfang and VIP databases were searched for all the literature on the use of robot-assisted laparoscopic nephrectomy or partial nephrectomy for the treatment of horseshoe kidney combined with renal tumor from the time of establishment to December 2022.Results:A total of 11 patients from 10 articles were retrieved and 12 patients were enrolled. Among the 12 patients, 4 cases used the retroperitoneal approach and 8 cases used the transperitoneal approach. Two cases were operated by traditional laparoscope, and the arteries were searched for and controlled before the robotic arm was placed to perform the partial nephrectomy and suture; and 10 cases were operated with the robotic-assisted laparoscopic approach throughout the whole procedure. Five cases of nephrectomy were performed on one side, and 7 cases were performed in the partial nephrectomy. Postoperative pathological diagnosis was clear cell carcinoma in 8 cases, chromophobe cell carcinoma in 1 case, eosinophilic cell carcinoma in 1 case, renal cell carcinoma in 1 case, and renal abscess in 1 case. The patient in the Second Hospital of Dalian Medical University was 38 years old female who was admitted to the hospital with a fever. After CT arteriography and three-dimensional reconstruction, robotic-assisted laparoscopic partial nephrectomy of right kidney and isthmus dissecting was performed. During the operation, tumor trophoblast vessels were ligated and dissected one by one by using single-use tissue closure clips, and the isthmus was dissected using endoscopic cutting anastomosis on the left side of the tumor, with the tumor edges sharply resected and completely dissected. The operation time was 240 min, without thermal ischemia time, and the bleeding volume was about 300 ml. The patient recovered well after the operation, and the postoperative pathological diagnosis was renal abscess.Conclusions:Robot-assisted laparoscopic treatment of horseshoe kidney combined with renal tumor is safe and effective, and has more advantages than traditional laparoscopic surgery. Preoperative CT arteriography or three-dimensional reconstruction examination should be applied to fully evaluate the variant vessels. The surgical access and plan should be decided according to the size and location of the tumor. The variant vessels should be properly handled during operation. The use of endoscopic cutting anastomosis to deal with the isthmus can be more conducive to the surgical operation.
RÉSUMÉ
【Objective】 To explore the factors influencing the survival and prognosis of patients with bladder urothelial carcinoma (BUC) after surgical treatment, and to establish an artificial intelligence algorithm to predict the effects of different surgical regimens. 【Methods】 BUC patients treated with surgery during Jan.2007 and Jan.2019 in The Second Hospital of Dalian Medical University and Nanfang Hospital of Southern Medical University were enrolled. The complete clinical and follow-up data were collected. Deep neural network (DNN) was used to establish an artificial intelligence algorithm model. A prediction model of survival and prognosis was established, and the influencing factors of survival were explored and ranked by the artificial intelligence algorithm. 【Results】 A total of 832 patients were involved, including 438 (52.64%) treated in The Second Hospital of Dalian Medical University, and 394 (47.36%) treated in Nanfang Hospital of Southern Medical University. Of all cases, 579 (69.6%) were non-muscle invasive bladder cancer, and 253 (30.4%) were muscle invasive bladder cancer. Transurethral resection of bladder tumor was conducted in 539 (64.8%) cases, partial cystectomy in 66 (7.9%) cases, and total cystectomy in 227 (27.3%) cases. The data of patients treated in Second Hospital of Dalian Medical University were used for DNN modeling, and the data of patients treated in Nanfang Hospital of Southern Medical University were used for external verification after modeling. Finally, it was concluded that the factors affecting survival and prognosis were T stage, pathological grade, hypertension or cardiovascular and cerebrovascular disease, hemoglobin, blood calcium, smoking, albumin, lymphocytes, age, ratio of albumin/globulin, operation method, N stage, and creatinine clearance rate in descending order. The model could be used for preoperative prediction. 【Conclusion】 Through DNN modeling and external verification, the influencing factors of postoperative survival can be predicted for patients with bladder cancer, and the surgical effects can also be predicted before operation. The model can provide artificial intelligence algorithm support for the selection of surgical methods and postoperative follow-up plans.
RÉSUMÉ
Objective:To analyze the clinical features of absolute incidental prostate cancer (AIPCa) and pseudo-incidental prostate cancer (PIPCa).Methods:Between January 2013 and October 2019, 52 male patients who were diagnosed as incidental prostate cancer (IPCa) with their postoperative pathological examination in our center were included. None of them had any evidence of prostate cancer before. Their median age was 77.5(ranging 55-93) years old. 48 cases underwent PSA examination. The median tPSA was 6.7 (ranging 1-46) ng/ml, except 1 case tPAS>100ng/ml. The median IPSS score was 27.7(ranging 12-35). 48 cases accepted prostatic ultrasound examination. The median prostate volume was 38.6 (ranging 2.3-130.2)ml. Among them, 13 patients underwent transurethral resection of the prostate (TURP), 24 patients underwent transurethral enucleation and resection of the prostate(TUERP), 15 patients underwent radical cystoprostatectomy(RCP). According to the patients′ preoperative examination, AIPCa and PIPCa were redefined. Clinical characteristics, postoperative pathology and follow-up of the two groups were compared and analyzed.Results:There was no significant difference in age, IPSS score, tPSA, T stage and Gleason score between the operation methods groups except for prostate volume and resection ration of prostate ( P>0.05). Among those group, the sequence of prostatic resection ration was RCP>TUERP>TURP( P<0.001). There was no significant difference in age, IPSS score, prostate volume, proportion of T 1b and Gleason score between AIPCa and PIPCa groups. However, the analysis showed higher tPSA(14.68 ng/ml vs. 3.14 ng/ml) in PIPCa ( P<0.001). With a mean follow-up of 33 months(ranging 6-78 months), 23.8%(5/21) patients in AIPCa group and 45.2%(14/31) patients in PIPCa group were found to have increased PSA and underwent radical prostatectomy or androgen deprivation therapy in the follow-up. There was no metastasis or death in AIPCa group, while 2 patients had bone metastasis and 1 patient died of prostate cancer in PIPCa group. Conclusions:According to the indication of prostate biopsy, PIPCa and AIPCa were defined. PIPCa has a relatively poor prognosis, some of them may be missed diagnosis and clinical underestimation. In order to avoid missed diagnosis before operation, we should strictly define IPCa and follow the indications of biopsy, emphasize the reference value of PSA in tumor screening and biopsy, and careful handle the negative results of biopsy when PSA is abnormal.