المؤلفون: Chan, Vinson Wai-Shun¹ (AUTHOR), Ng, Helen Hoi-Lam^1,2 (AUTHOR), Wah, Tze Min^1,2 (AUTHOR) tze.wah@nhs.net

المصدر: Seminars in Interventional Radiology. Apr2024, Vol. 41 Issue 2, p144-153. 10p.

مصطلحات موضوعية: *KIDNEY tumors, *SURGICAL robots, *ABLATION techniques, *CANCER relapse, *ARTIFICIAL intelligence, *NEPHRECTOMY, *TREATMENT effectiveness, *CRYOSURGERY, *COMPUTER-assisted surgery, *METASTASIS, *SURGICAL complications, *INTERVENTIONAL radiology, *PROGRESSION-free survival, *OVERALL survival

مستخلص: Image-guided ablation (IGA) is a rapidly developing field in interventional oncology. There is some evidence suggesting IGA's non-inferiority compared with partial or radical nephrectomy for the treatment of small renal masses (SRM). However, these are mostly limited to retrospective cohort studies. This review article outlines the evidence comparing IGA to partial nephrectomy by collating the different survival measures and evaluates the challenges of producing clinical trials and high-quality evidence. The main challenges are due to the heterogeneity of SRM, patient selection bias, unstandardized endpoint and outcomes, and the lack of global practice standards. Despite the evidence thus far demonstrating that IGA stands as a non-inferior treatment modality for SRMs, exhibiting favorable short- and long-term outcomes, further robust research is needed to integrate ablation techniques into routine clinical practice with a multidisciplinary approach. There is emerging evidence that suggests randomized controlled trial in SRMs is possible, and technologies such as histotripsy as well as artificial intelligence are used in IGA. [ABSTRACT FROM AUTHOR]

المؤلفون: Pirola, Giacomo Maria, Castellani, Daniele, Lim, Ee Jean, Wroclawski, Marcelo Langer, Le Quy Nguyen, Dong, Gubbiotti, Marilena, Rubilotta, Emanuele, Chan, Vinson Wai-Shun, Corrales, Mariela, Rojo, Esther Garcia, Herrmann, Thomas R. W., Teoh, Jeremy Yuen-Chun, Gauhar, Vineet

المصدر: World Journal of Urology; Jun2022, Vol. 40 Issue 6, p1391-1411, 21p

مصطلحات موضوعية: URETHRA stricture, PROSTATE surgery, RANDOM effects model, ENDOSCOPIC surgery, TRANSURETHRAL prostatectomy, BENIGN prostatic hyperplasia

مستخلص: Introduction and objectives: This systematic review aims to evaluate the incidence and influencing factors of urethral stricture (US) in relation to different BPH endoscopic techniques. Materials and methods: We performed a systematic literature review using MEDLINE, EMBASE, and Cochrane Central Controlled Register of Trials. The incidence of US was estimated through comparative studies between different endoscopic techniques. Patients were assigned into groups according to the type of surgery (enucleation, ablation and resection group). Incidences of US were pooled using the Cochran-Mantel-Haenszel Method with the random effect model and reported as Risk Ratio (RR), 95% Confidence Intervals (CI), and p-values. Results: A total of 80 studies were included for meta-analysis. The pooled incidence of US was 1.7% after enucleation, 2.1% after ablation, 3.8% after monopolar (M)-TURP and 2.1% after bipolar (B)-TURP. The incidence of US was significantly lower after Enucleation than after TURP (RR 0.58 95% CI 0.39–0.84, p = 0.004). US incidence was lower for Ablation procedures than TURP, but the difference did not reach significance (RR 0.79 95% CI 0.61–1.3, p = 0.08). However, this was significant in the subgroup of M-TURP studies (RR 0.67, 95% CI, 0.49–0.91, p = 0.01). Sub-analysis showed that the risk of US was significantly lower after Enucleation than after TURP within 12 months after surgery (RR 0.51 95% CI 0.33–0.81, p = 0.004). Conclusion: The study shows an increased incidence of US after TURP compared to enucleation and ablation procedures. The main factors related to increased US incidence are the use of monopolar energy, instrument caliber and duration of postoperative catheterization. [ABSTRACT FROM AUTHOR]

: Copyright of World Journal of Urology is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Chan, Vinson Wai-Shun, Abul, Ahmad, Osman, Filzah Hanis, Ng, Helen Hoi-Lam, Wang, Kaiwen, Yuan, Yuhong, Cartledge, Jon, Wah, Tze Min

المصدر: International Journal of Surgery; Jan2022, Vol. 97, pN.PAG-N.PAG, 1p

مصطلحات موضوعية: RENAL cell carcinoma, GLOMERULAR filtration rate, NEPHRECTOMY, KIDNEYS, META-analysis, SYSTEMATIC reviews, TREATMENT effectiveness, KIDNEY tumors

مستخلص: Background: High quality studies and reviews on the management of small renal masses (SRM) are lacking. This review aims to compare oncological outcomes in patients undergoing ablative therapies (AT) or partial nephrectomy (PN) for T1a or T1b SRM.Material and Methods: Medline, EMBASE, Cochrane CENTRAL and conference proceedings were searched on the 15th July 2020 for comparative studies respective to our research question. The ROBINS-I tool and the GRADE approach were used to assess any risk of biases and certainty of evidence in the included studies. The review is registered on PROSPERO.Results: 1,748 records were retrieved. 32 observational studies and 1 RCT integrating 74,946 patients were included. Patients undergoing AT patients are significantly older than PN patients (MD 5.70, 95%CI 3.83-7.58). In T1a patients, AT patients have significantly worse overall survival (HR 1.64, 95%CI 1.39-1.95). Local recurrence-free survival is similar with PN in patients with longer than five-years follow up (HR 1.54, 95%CI 0.88-2.71). AT patients also have similar cancer-specific survival (CSS), metastasis-free survival, disease-free survival, significantly fewer post-operative complications (RR 0.72, 95%CI 0.55-0.94), and a smaller decline in estimated glomerular filtration rate post-operatively (MD: -7.42, 95%CI -13.1 to -1.70) compared to those undergoing PN. Evidence contradicts in T1b patients for oncological outcomes.Conclusions: AT have similar long-term oncological durability; lower rates of complications and superior kidney function preservation compared to PN. Given the low quality of evidence, AT is a reasonable alternative to PN in frail and co-morbid patients. Long-term high-quality studies are needed to confirm the potential benefits of AT, especially in T1b patients.Prospero Registration: CRD42020199099. [ABSTRACT FROM AUTHOR]

: Copyright of International Journal of Surgery is the property of Wolters Kluwer Health and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)