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Current Oncology
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Radical Surgery Advances in Oncology
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Radical Surgery Advances in Oncology

A special issue of Current Oncology (ISSN 1718-7729). This special issue belongs to the section "Surgical Oncology".

Deadline for manuscript submissions: closed (31 December 2022) | Viewed by 11783

Special Issue Editors

Dr. Giuseppe Simone

E-Mail Website
Guest Editor
Department of Urologic Oncology, IRCCS “Regina Elena” National Cancer Institute, Rome, Italy
Interests: robotics; laparoscopy; prostate cancer; renal cancer; bladder cancer
Special Issues, Collections and Topics in MDPI journals
Dr. Umberto Anceschi

E-Mail Website
Guest Editor
Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
Interests: prostate cancer; renal cancer; bladder cancer; urological cancer

Special Issue Information

Dear Colleagues,

With the progressive implementation of robotic surgery and novel technologies availability, the management of urological malignancies is rapidly evolving. In this Special Issue we will provide an overview of the most recent either surgical or clinical advances achieved in major uro-oncologic procedures ranging from the state of the art for milestone techniques such as laparoscopic radical nephrectomy to the latest innovations achieved in bladder and renal cancer landscapes.

We are pleased to invite you to provide a contribution to a Special Issue entitled “Radical Surgery Advances in Oncology”.

This Special Issue aims to provide an insight in the latest clinical and technological advancements in major uro-oncologic procedures.

The Special Issue will focus on the following topics:

  • Novel approaches to radical prostatectomy
  • Introduction of novel technologies in the uro-pathologic specimens’ evaluation
  • New scoring system for the assessment of surgical quality and functional outcomes for the treatment of urologic cancers
  • Real-time application of 3D technology to robotic platforms during major uro-oncologic surgery
  • Evolution of surgical indications according to robotic surgery and ancillary technologies
  • Robotic management of urologic complications during pelvic oncologic surgery

Dr. Giuseppe Simone
Dr. Umberto Anceschi
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Current Oncology is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • prostate cancer
  • bladder cancer
  • renal cancer
  • penile cancer
  • robotics
  • trifecta
  • scoring system
  • complications
  • confocal microscopy
  • radiomics

Published Papers (7 papers)

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12 pages, 4988 KiB  
Article
New Generation of 3D Virtual Models with Perfusional Zones: Perioperative Assistance for the Best Pedicle Management during Robotic Partial Nephrectomy
by Daniele Amparore, Federico Piramide, Paolo Verri, Enrico Checcucci, Sabrina De Cillis, Alberto Piana, Gabriele Volpi, Mariano Burgio, Giovanni Busacca, Marco Colombo, Cristian Fiori and Francesco Porpiglia
Curr. Oncol. 2023, 30(4), 4021-4032; https://doi.org/10.3390/curroncol30040304 - 01 Apr 2023
Cited by 7 | Viewed by 1290
Abstract
Selective clamping during robot-assisted partial nephrectomy (RAPN) may reduce ischemia-related functional impairment. The intraoperative use of 3D-virtual models (3DVMs) can improve surgical planning, resulting in a greater success rate for selective clamping. Our goal is to introduce a new generation of 3DVMs, which [...] Read more.
Selective clamping during robot-assisted partial nephrectomy (RAPN) may reduce ischemia-related functional impairment. The intraoperative use of 3D-virtual models (3DVMs) can improve surgical planning, resulting in a greater success rate for selective clamping. Our goal is to introduce a new generation of 3DVMs, which consider the perfusion volumes of the kidney. Patients listed for RAPN from 2021 to 2022 were recruited. A selective clamping strategy was designed and intraoperatively performed based on the specifically generated 3DVMs. The effectiveness of selective clamping was evaluated using near-infrared-fluorescence imaging (NIRF) and 3DVM. Perfusion areas extensions were compared, and relevant preoperative characteristics were analyzed. In 61 of 80 (76.25%) cases, selective clamping was performed. The concordance between the 3DVM areas and the NIRF-enhanced areas was verified (k = 0.91). According to the distribution of perfused areas crossing the tumor, there were one, two, three, four, and five crossing areas, with relative perfusion rates of 13.75%, 35%, 32.5%, 13.75%, and 5%, respectively. Lesion diameter and mesorenal location were the only factors related to a higher number (>3) of perfusion volumes crossing the lesion. The implementation of mathematical algorithms to 3DVMs allows for precise estimation of the perfusion zone of each arterial branch feeding the organ, leading to the performance of safe and effective pedicle management planning. Full article
(This article belongs to the Special Issue Radical Surgery Advances in Oncology)
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11 pages, 1144 KiB  
Article
Real-Time Urethral and Ureteral Assessment during Radical Cystectomy Using Ex-Vivo Optical Imaging: A Novel Technique for the Evaluation of Fresh Unfixed Surgical Margins
by Francesco Prata, Umberto Anceschi, Chiara Taffon, Silvia Maria Rossi, Martina Verri, Andrea Iannuzzi, Alberto Ragusa, Francesco Esperto, Salvatore Mario Prata, Anna Crescenzi, Roberto Mario Scarpa, Giuseppe Simone and Rocco Papalia
Curr. Oncol. 2023, 30(3), 3421-3431; https://doi.org/10.3390/curroncol30030259 - 15 Mar 2023
Cited by 3 | Viewed by 1422
Abstract
Background: Our study aims to assess the feasibility and the reproducibility of fluorescent confocal microscopy (FCM) real-time assessment of urethral and ureteral margins during open radical cystectomy (ORC) for bladder cancer (BCa). Methods: From May 2020 to January 2022, 46 patients underwent ORC [...] Read more.
Background: Our study aims to assess the feasibility and the reproducibility of fluorescent confocal microscopy (FCM) real-time assessment of urethral and ureteral margins during open radical cystectomy (ORC) for bladder cancer (BCa). Methods: From May 2020 to January 2022, 46 patients underwent ORC with intraoperative FCM evaluation. Each specimen was intraoperatively stained for histopathological analysis using FCM, analyzed as a frozen section (FSA), and sent for traditional H&E examination. Sensitivity, specificity, positive predictive value (PPV), and the negative predictive value (NPV) of FCM and FSA were assessed and compared with H&E for urethral and ureteral margins separately. Results: The agreement was evaluated through Cohen’s κ statistic. Urethral diagnostic agreement between FCM and FSA showed a κ = 0.776 (p < 0.001), while between FCM and H&E, the agreement was κ = 0.691 (p < 0.001). With regard to ureteral margins, an overall agreement of κ = 0.712 (p < 0.001) between FCM and FSA and of κ = 0.481 (p < 0.001) between FCM and H&E was found. Conclusions: FCM proved to be a safe, feasible, and reproducible method for the intraoperative assessment of urethral and ureteral margins during ORC. Compared to standard FSA, FCM showed adequate diagnostic performance in detecting urethral and ureteral malignant involvement. Full article
(This article belongs to the Special Issue Radical Surgery Advances in Oncology)
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11 pages, 1017 KiB  
Article
Radiomic Machine-Learning Analysis of Multiparametric Magnetic Resonance Imaging in the Diagnosis of Clinically Significant Prostate Cancer: New Combination of Textural and Clinical Features
by Francesco Prata, Umberto Anceschi, Ermanno Cordelli, Eliodoro Faiella, Angelo Civitella, Piergiorgio Tuzzolo, Andrea Iannuzzi, Alberto Ragusa, Francesco Esperto, Salvatore Mario Prata, Rosa Sicilia, Giovanni Muto, Rosario Francesco Grasso, Roberto Mario Scarpa, Paolo Soda, Giuseppe Simone and Rocco Papalia
Curr. Oncol. 2023, 30(2), 2021-2031; https://doi.org/10.3390/curroncol30020157 - 07 Feb 2023
Cited by 5 | Viewed by 1691
Abstract
Background: The aim of our study was to develop a radiomic tool for the prediction of clinically significant prostate cancer. Methods: From September 2020 to December 2021, 91 patients who underwent magnetic resonance imaging prostate fusion biopsy at our institution were selected. Prostate [...] Read more.
Background: The aim of our study was to develop a radiomic tool for the prediction of clinically significant prostate cancer. Methods: From September 2020 to December 2021, 91 patients who underwent magnetic resonance imaging prostate fusion biopsy at our institution were selected. Prostate cancer aggressiveness was assessed by combining the three orthogonal planes-Llocal binary pattern the 3Dgray level co-occurrence matrix, and other first order statistical features with clinical (semantic) features. The 487 features were used to predict whether the Gleason score was clinically significant (≥7) in the final pathology. A feature selection algorithm was used to determine the most predictive features, and at the end of the process, nine features were chosen through a 10-fold cross validation. Results: The feature analysis revealed a detection accuracy of 83.5%, with a clinically significant precision of 84.4% and a clinically significant sensitivity of 91.5%. The resulting area under the curve was 80.4%. Conclusions: Radiomic analysis allowed us to develop a tool that was able to predict a Gleason score of ≥7. This new tool may improve the detection rate of clinically significant prostate cancer and overcome the limitations of the subjective interpretation of magnetic resonance imaging, reducing the number of useless biopsies. Full article
(This article belongs to the Special Issue Radical Surgery Advances in Oncology)
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11 pages, 754 KiB  
Article
Combined Reporting of Surgical Quality and Cancer Control after Surgical Treatment for Penile Tumors with Inguinal Lymph Node Dissection: The Tetrafecta Achievement
by Aldo Brassetti, Umberto Anceschi, Gabriele Cozzi, Julian Chavarriaga, Pavel Gavrilov, Josep Maria Gaya Sopena, Alfredo Maria Bove, Francesco Prata, Mariaconsiglia Ferriero, Riccardo Mastroianni, Leonardo Misuraca, Gabriele Tuderti, Giulia Torregiani, Marco Covotta, Diego Camacho, Gennaro Musi, Rodolfo Varela, Alberto Breda, Ottavio De Cobelli and Giuseppe Simone
Curr. Oncol. 2023, 30(2), 1882-1892; https://doi.org/10.3390/curroncol30020146 - 03 Feb 2023
Cited by 2 | Viewed by 1667
Abstract
Background: To optimize results reporting after penile cancer (PC) surgery, we proposed a Tetrafecta and assessed its ability to predict overall survival (OS) probabilities. Methods: A purpose-built multicenter, multi-national database was queried for stage I–IIIB PC, requiring inguinal lymphadenectomy (ILND), from 2015 onwards. [...] Read more.
Background: To optimize results reporting after penile cancer (PC) surgery, we proposed a Tetrafecta and assessed its ability to predict overall survival (OS) probabilities. Methods: A purpose-built multicenter, multi-national database was queried for stage I–IIIB PC, requiring inguinal lymphadenectomy (ILND), from 2015 onwards. Kaplan–Meier (KM) method assessed differences in OS between patients achieving Tetrafecta or not. Univariable and multivariable regression analyses identified its predictors. Results: A total of 154 patients were included in the analysis. The 45 patients (29%) that achieved the Tetrafecta were younger (59 vs. 62 years; p = 0.01) and presented with fewer comorbidities (ASA score ≥ 3: 0% vs. 24%; p < 0.001). Although indicated, ILND was omitted in 8 cases (5%), while in 16, a modified template was properly used. Although median LNs yield was 17 (IQR: 11–27), 35% of the patients had <7 nodes retrieved from the groin. At Kaplan–Maier analysis, the Tetrafecta cohort displayed significantly higher OS probabilities (Log Rank = 0.01). Uni- and multivariable logistic regression analyses identified age as the only independent predictor of Tetrafecta achievement (OR: 0.97; 95%CI: 0.94–0.99; p = 0.04). Conclusions: Our Tetrafecta is the first combined outcome to comprehensively report results after PC surgery. It is widely applicable, based on standardized and reproducible variables and it predicts all-cause mortality. Full article
(This article belongs to the Special Issue Radical Surgery Advances in Oncology)
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10 pages, 1408 KiB  
Article
Purely Off-Clamp Laparoscopic Partial Nephrectomy Stands the Test of Time: 15 Years Functional and Oncologic Outcomes from a Single Center Experience
by Aldo Brassetti, Umberto Anceschi, Alfredo Maria Bove, Francesco Prata, Manuela Costantini, Mariaconsiglia Ferriero, Riccardo Mastroianni, Leonardo Misuraca, Gabriele Tuderti, Giulia Torregiani, Marco Covotta, Michele Gallucci and Giuseppe Simone
Curr. Oncol. 2023, 30(1), 1196-1205; https://doi.org/10.3390/curroncol30010092 - 15 Jan 2023
Cited by 5 | Viewed by 1493
Abstract
Background: Nephron-sparing surgery represents the gold standard treatment for organ-confined renal tumors. We present 15-years of outcomes after off-clamp laparoscopic partial nephrectomy (ocLPN). Methods: a retrospective analysis was performed on patients who underwent ocLPN between May 2001 and December 2005. Baseline demographic, clinical, [...] Read more.
Background: Nephron-sparing surgery represents the gold standard treatment for organ-confined renal tumors. We present 15-years of outcomes after off-clamp laparoscopic partial nephrectomy (ocLPN). Methods: a retrospective analysis was performed on patients who underwent ocLPN between May 2001 and December 2005. Baseline demographic, clinical, pathologic, surgical, functional and survival data were collected. The Kaplan–Meier method evaluated group-specific oncologic outcomes at 5, 10 and 15 years and the log rank test assessed differences between groups. The same analysis investigated the probabilities of developing a significant renal function impairment (sRFI) and achieving ROMeS. Cox analyses identified predictors of this latter tricomposite outcome. Results: We included 63 patients whose median tumor size was 3 cm (IQR:2–4). At 15 years, the chances of developing local recurrence, metachronous renal cancers or distant metastases were 2 ± 2%, 23 ± 6% and 17 ± 5%, respectively. Consequently, disease-free, cancer-specific and overall-survival probabilities were 68 ± 6%, 90 ± 4% and 72 ± 6%. MCRSS and UCISS well predicted oncologic outcomes. Overall, nine (14%) patients experienced an sRFI and 33 (52%) achieved ROMeS. Age (HR: 1.046; p = 0.033) and malignant histology (low-risk cancers HR: 3.233, p = 0.048) (intermediate/high risk cancers HR: 5.721, p = 0.023) were independent predictors of ROMeS non-achievement. Conclusions: At 15 years from ocLPN, most of patients will experience both excellent functional and oncologic outcomes. Full article
(This article belongs to the Special Issue Radical Surgery Advances in Oncology)
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12 pages, 12249 KiB  
Article
“Urethral-Sparing” Robotic Radical Prostatectomy: Critical Appraisal of the Safety of the Technique Based on the Histologic Characteristics of the Prostatic Urethra
by Anastasios D. Asimakopoulos, Filippo Annino, Gaia Colalillo, Richard Gaston, Thierry Piechaud, Alessandro Mauriello, Umberto Anceschi and Filippo Borri
Curr. Oncol. 2023, 30(1), 1065-1076; https://doi.org/10.3390/curroncol30010082 - 12 Jan 2023
Cited by 4 | Viewed by 1754
Abstract
Background: The prostatic urethra (PU) is conventionally resected during robot-assisted radical prostatectomy (RALP). Recent studies demonstrated the feasibility of the extended PU preservation (EPUP). Aims: To describe the histologic features of the PU. Methods: The PU was evaluated using cystoprostatectomy and RALP specimens. [...] Read more.
Background: The prostatic urethra (PU) is conventionally resected during robot-assisted radical prostatectomy (RALP). Recent studies demonstrated the feasibility of the extended PU preservation (EPUP). Aims: To describe the histologic features of the PU. Methods: The PU was evaluated using cystoprostatectomy and RALP specimens. Cases of PU infiltration by prostate cancer or distortion by benign hyperplastic nodules were excluded. The thickness of the chorion and distance between the urothelium and prostate glands were measured. Prostate-specific antigen expression in the PU epithelium was evaluated with immunohistochemistry. Descriptive statistics were used. Results: Six specimens of PU were examined. Histologically, the following layers of the PU were observed: (1) urothelium with basal membrane, (2) chorion, and (3) prostatic peri-urethral fibromuscular tissue. The chorion measures between 0.2 and 0.4 mm. There is not a distinct urethral muscle layer, but rather muscular fibers that originate near the prostatic stroma and are distributed around the PU. This muscular tissue appears to be mainly represented in the basal and apical urethra, but not in the middle urethra. The mean distance between the chorion and prostatic glands is 1.74 mm, with significant differences between base of the prostate, middle urethral portion, and apex (2.5 vs. 1.49 vs. 1.23 mm, respectively). PSA-expressing cells are abundant in the PU epithelium, coexisting with urothelial cells. Conclusions: The exiguity of thickness of the PU chorion, short distance from glandular tissue, and coexistence of PSA-expressing cells in the epithelium raise important concerns about the oncologic safety of EPUP. Full article
(This article belongs to the Special Issue Radical Surgery Advances in Oncology)
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9 pages, 3154 KiB  
Case Report
Incorporating VR-RENDER Fusion Software in Robot-Assisted Partial Prostatectomy: The First Case Report
by Che-Hsueh Yang, Li-Hsun Chen, Yi-Sheng Lin, Chao-Yu Hsu, Min-Che Tung, Shih-Wei Huang, Chi-Hsiang Wu and Yen-Chuan Ou
Curr. Oncol. 2023, 30(2), 1699-1707; https://doi.org/10.3390/curroncol30020131 - 31 Jan 2023
Cited by 2 | Viewed by 1668
Abstract
Currently, the active surveillance of men with favorable intermediate-risk localized prostate cancer (PCa) is a longstanding controversy, in terms of their oncological outcomes, and radical prostatectomy would constitute a similar concern of overtreatment, regarding its functional outcomes. Thus, focal therapy could be considered [...] Read more.
Currently, the active surveillance of men with favorable intermediate-risk localized prostate cancer (PCa) is a longstanding controversy, in terms of their oncological outcomes, and radical prostatectomy would constitute a similar concern of overtreatment, regarding its functional outcomes. Thus, focal therapy could be considered in men belonging to favorable intermediate-risk group. Among all focal therapies, high-intensity focused ultrasound (HIFU) was the most studied methodology in clinical trials. Although HIFU provided better functional outcomes than radical prostatecomy, the oncological outcomes were inferior in men with intermediate-risk localized PCa. Two articles have been published discussing the feasibility and clinical outcomes of robot-assisted partial prostatectomy (RAPP), and both the functional and oncological outcomes were superior than those with HIFU. However, the rate of positive surgical margins (PSMs) was reported as high in the literature. Here, we present a case of favorable intermediate-risk localized PCa with an isolated tumor at the anterior apex. After reconstructing a personal three-dimensional (3D) image, we utilized it in a 3D image-guided precise excise, followed by intraoperative frozen specimen review. We found that this method may present a resolution to the high PSM rate documented in the current literature regarding RAPP. This method merits further study with a well-designed prospective study. Full article
(This article belongs to the Special Issue Radical Surgery Advances in Oncology)
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