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Current strategies to diagnose and manage positive surgical margins and local recurrence after partial nephrectomy

Asian Journal of Urology 2022年第3期9卷 227-242页

作者： Umberto Carbonara Daniele Amparore Cosimo Gentile Riccardo Bertolo Selcuk Erdem Alexandre Ingels Michele Marchioni Constantijn H.J.Muselaers Onder Kara laura marandino Nicola Pavan Eduard Roussel Angela Pecoraro Fabio Crocerossa Giuseppe Torre Riccardo Campi Pasquale Ditonno European Association of Urology(EAU) Young Academic Urologists(YAU)Renal Cancer Working Group Department of Emergency and Organ Transplantation-Urology Andrology and Kidney Transplantation UnitUniversity of BariBariItaly Division of Urology Department of OncologySchool of MedicineSan Luigi HospitalUniversity of TurinOrbassanoTurinItaly Department of Urology San Carlo Di Nancy HospitalRomeItaly Division of Urologic Oncology Department of UrologyIstanbul University Istanbul Faculty of MedicineIstanbulTurkey Department of Urology University Hospital Henri MondorAPHPCreteilFrance Department of Urology SS Annunziata Hospital"G.D’Annunzio"University of ChietiChietiItaly Department of Urology Radboud University Medical CenterNijmegenthe Netherlands Department of Urology Kocaeli University School of MedicineKocaeliTurkey Department of Medical Oncology IRCCS Ospedale San RaffaeleVita-Salute San Raffaele UniversityMilanItaly Urology Clinic Department of MedicalSurgical and Health ScienceUniversity of TriesteTriesteItaly Department of Urology University Hospitals LeuvenLeuvenBelgium Department of Urology Magna Graecia University of CatanzaroCatanzaroItaly Unit of Urological Robotic Surgery and Renal Transplantation University of FlorenceCareggi HospitalFlorenceItaly

Objective:No standard strategy for diagnosis and management of positive surgical margin(PSM)and local recurrence after partial nephrectomy(PN)are reported in *** review aims to provide an overview of the current strategies and further perspectives on this patient ***:A non-systematic review of the literature was *** research included the most updated articles(about the last 10 years).Results:Techniques for diagnosing PSMs during PN include intraoperative frozen section,imprinting cytology,and other specific *** clear evidence is reported about these *** PSM management,active surveillance with a combination of imaging and laboratory evaluation is the first option line followed by *** local recurrence management,surgery is the primary curative approach when possible but it may be technically difficult due to anatomy resultant from previous *** this scenario,thermal ablation(TA)may have the potential to circumvent these limitations representing a less invasive *** surgery represents a valid option;six studies analyzed the outcomes of nephrectomy on local recurrence after PN with three of these focused on robotic ***all,complication rates of salvage surgery are higher compared to TA but ablation presents a higher recurrence rate up to 25%of cases that can often be managed with repeat ***:Controversy still exists surrounding the best strategy for management and diagnosis of patients with PSMs or local recurrence after *** surveillance is likely to be the optimal first-line management option for most patients with *** and salvage surgery both represent valid options in patients with local recurrence after ***,salvage PN and radical nephrectomy have fewer recurrences but are associated with a higher complication rate compared to *** this scenario,robotic surgery plays an important role in improving salvage PN and radical nephrectom

关键词： Positive surgical margin Local recurrence Partial nephrectomy Radical nephrectomy Robot-assisted partial nephrectomy

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Potential benefit of lymph node dissection during radical nephrectomy for kidney cancer:A review and critical analysis of current literature

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Asian Journal of Urology 2022年第3期9卷 215-226页

作者： Michele Marchioni Daniele Amparore Igino Andrea Magli Riccardo Bertolo Umberto Carbonara Selcuk Erdem Alexandre Ingels Constantijn H.J.Muselaers Onder Kara Marco Mascitti Tobias Klatte Maximilian Kriegmair Nicola Pavan Eduard Roussel Angela Pecoraro laura marandino Riccardo Campi Luigi Schips Department of Urology SS Annunziata Hospital“G.D’Annunzio”University of ChietiChietiItaly Division of Urology Department of OncologySchool of MedicineSan Luigi HospitalUniversity of TurinOrbassanoTurinItaly Department of Urology San Carlo Di Nancy HospitalRomeItaly Department of Emergency and Organ Transplantation-Urology Andrology and Kidney Transplantation UnitUniversity of BariBariItaly Division of Urologic Oncology Department of UrologyIstanbul University Istanbul Faculty of MedicineIstanbulTurkey Department of Urology University Hospital Henri MondorAPHPCreteilFrance Department of Urology Radboud University Medical CenterNijmegenthe Netherlands Department of Urology Kocaeli University School of MedicineKocaeliTurkey Department of Urology Royal Bournemouth HospitalBournemouthUK Department of Urology University Medical Centre MannheimMannheimGermany Urology Clinic Department of MedicalSurgical and Health ScienceUniversity of TriesteTriesteItaly Department of Urology University Hospitals LeuvenLeuvenBelgium Department of Medical Oncology Fondazione IRCCS Istituto Nazionale dei TumoriMilanItaly Unit of Urological Robotic Surgery and Renal Transplantation University of FlorenceCareggi HospitalFlorenceItaly

Objective:The role of lymph node dissection(LND)is still controversial in patients with renal cell carcinoma undergoing *** aimed to provide a comprehensive review of the literature about the effect of LND on survival,prognosis,surgical outcomes,as well as patient selection and available LND ***:Recent literature(from January 2011 to December 2021)was assessed through PubMed and MEDLINE databases.A narrative review of most relevant articles was ***:The frequencies in which LNDs are being carried out are decreasing due to an increase in minimally invasive and nephron sparing ***,randomized clinical trials and meta-analyses failed to show any survival advantage of LND versus no ***,retrospective studies suggest a survival benefit of LND in high-risk patients(bulky tumors,T3-4 stage,and cN1 patients).Moreover,extended LND might provide important staging information,which could be of interest for adjuvant treatment ***:No level 1 evidence of any survival advantage deriving from LND is currently available in ***,the role of LND is limited to staging ***,low grade evidence suggests a possible role of LND in high-risk *** clinical trials are warranted to corroborate these findings.

关键词： Renal cell carcinoma Lymph node dissection Radical nephrectomy Salvage lymph node dissection

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Multidisciplinary management of patients diagnosed with von Hippel-Lindau disease: A practical review of the literature for clinicians

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Asian Journal of Urology 2022年第4期9卷 430-442页

作者： Alessandro Larcher Federico Belladelli Giuseppe Fallara Isaline Rowe Umberto Capitanio laura marandino Daniele Raggi Jody Filippo Capitanio Michele Bailo Rosangela Lattanzio Costanza Barresi Sonia Francesca Calloni Maurizio Barbera Valentina Andreasi Giorgia Guazzarotti Giovanni Pipitone Paola Carrera Andrea Necchi Pietro Mortini Francesco Bandello Andrea Falini Stefano Partelli Massimo Falconi Francesco De Cobelli Andrea Salonia Ospedale San Raffaele VHL Research Program MilanItaly URI-Urological Research Institute Department of UrologyDivision of Experimental OncologyIRCCS Ospedale San RaffaeleMilanItaly Universita Vita-Salute San Raffaele MilanItaly Department of Oncology IRCCS Ospedale San RaffaeleMilanItaly Department of Neurosurgery IRCCS Ospedale San RaffaeleMilanItaly Department of Ophthalmology IRCCS Ospedale San RaffaeleMilanItaly Department of Neuroradiology IRCCS Ospedale San RaffaeleMilanItaly Pancreas Translational&Clinical Research Center OSR ENETS Center of ExcellenceUnit of Pancreatic SurgeryIRCCS Ospedale San RaffaeleMilanItaly Department of Radiology IRCCS Ospedale San RaffaeleMilanItaly Service of Laboratory Medicine Molecular Genetics Service and Clinical Genomics

Objective:The aim of the current review is to summarize the available evidence to aid clinicians in the surveillance,treatment and follow-up of the different primary tumors developed by patients diagnosed with von Hippel-Lindau(VHL)***:A non-systematic narrative review of original articles,meta-analyses,and random-ized trials was conducted,including articles in the pre-clinical setting to support relevant ***:VHL disease is the most common rare hereditary disorder associated with clear cell renal cell *** individuals inherit a germline mutation in one VHL allele,and any somatic event that disrupt the other allele can trigger mutations,chromosomal rearrange-ments,or epigenetic regulations leading to *** a clinical perspective,patients continuously develop multiple primary ***:Because VHL is considered a rare disease,very limited evidence is available for diagnosis,surveillance,active treatment with local or systemic therapy and follow-up.

关键词： Von Hippel-Lindau disease Rare tumor Genetic syndrome Clear cell renal cell carcinoma

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