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Abstract: Background: Intraoperative kidney tumor rupture (TR) can occur during robot-assisted partial nephrectomy (RAPN) in daily clinical practice, but there are no solid guidelines on the management and implications of it. The purpose of the study was to investigate the impact of TR on tumor recurrences, what a surgeon should do if this adverse event occurs, and how to avoid it. Patients and methods: We retrospectively analyzed the first 100 patients who underwent RAPN at University Medical Centre Ljubljana, between 2018 and 2021. Patients were stratified into 2 groups (TR and no-TR) and were compared according to patient, tumor, pathologic, perioperative and postoperative characteristics and tumor recurrences, using the Mann-Whitney U test and chi-squared test. Results: Of the 100 patients, 14 had TR (14%); this occurred in tumors with higher RENAL nephrometry scores (P = 0.028) and mostly with papillary renal cell carcinomas (P = 0.043). Median warm ischemia time was longer for the TR group (22 vs. 15 min, P = 0.026). In terms of studied outcomes, there were no cases of local or distant recurrence after a median observation time of 39 months (interquartile range, 31-47 months) in both groups. We observed positive surgical margins on the final oncologic report in one case in the no-TR group. Conclusions: Tumor rupture during RAPN seems to be of no mid-term oncologic importance. According to presented results, we would recommend surgeons to proceed with tumor resection if this event occurs and abstain from conversion to radical nephrectomy or open partial nephrectomy. However, more similar cases should be studied to make more solid conclusions.
Keywords: enucleation, renal cell carcinoma, robot-assisted partial nephrectomy, tumor recurrence, tumor rupture, warm ischemia time
Published in DiRROS: 25.07.2024; Views: 256; Downloads: 182
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Abstract: The aim of the study was to evaluate the independent prognostic role of PIK3CA activating mutationsand an association between PIK3CA activating mutations and efficacy of adjuvant endocrine therapy (ET) in patientswith operable invasive lobular carcinoma (ILC).Patients and methods.A single institution study of patients with early-stage ILC treated between 2003 and 2008 wasperformed. Clinicopathological parameters, systemic therapy exposure and outcomes (distant metastasis-free sur-vival [DMFS] and overall survival [OS]) were collected based on presence or absence of PIK3CA activating mutationin the primary tumor determined using a quantitative polymerase chain reaction (PCR)-based assay. An associationbetween PIK3CA mutation status and prognosis in all patient cohort was analyzed by Kaplan-Meier survival analysis,whereas an association between PIK3CA mutation and ET was analyzed in estrogen receptors (ER) and/or progester-one receptors (PR)-positive group of our patients by the Cox proportional hazards model.Results. Median age at diagnosis of all patients was 62.8 years and median follow-up time was 10.8 years. Among365 patients, PIK3CA activating mutations were identified in 45%. PIK3CA activating mutations were not associatedwith differential DMFS and OS (p = 0.36 and p = 0.42, respectively). In patients with PIK3CA mutation each year oftamoxifen (TAM) or aromatase inhibitor (AI) decreased the risk of death by 27% and 21% in comparison to no ET, re-spectively. The type and duration of ET did not have significant impact on DMFS, however longer duration of ET hada favourable impact on OS.Conclusions. PIK3CA activating mutations are not associated with an impact on DMFS and OS in early-stage ILC.Patients with PIK3CA mutation had a statistically significantly decreased risk of death irrespective of whether theyreceived TAM or an AI.
Keywords: invasive lobular carcinoma, PIK3CA mutation, endocrine therapy
Published in DiRROS: 25.07.2024; Views: 301; Downloads: 98
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Abstract: High grade gliomas are associated with cognitive problems. The aim of the study was to investigate cognitive functioning in a cohort of patients with high grade glioma, according to isocitrate dehydrogenase (IDH) and methyl guanine methyl transferase (MGMT) status and other clinical characteristics. The patients with the high-grade glioma treated in Slovenia in given period of time were included in study. Postoperatively they completed neuropsychological assessment consisting of Slovenian Verbal Learning Test, Slovenian Controlled Oral Word Association Test, Trail Making Test Part A and B and self-evaluation questionnaire. We analysed results (z-scores and dichotomized results) also according to IDH mutation and MGMT methylation. We examined differences between groups using T-test, Mann-Whitney U, χ2 and Kendall's Tau tests. Out of 275 patients in the cohort, we included 90. Forty-six percent of patients were unable to participate due to poor performance status and other conditions related to tumour. Patients with the IDH mutation were younger, with better performance status, larger proportions of grade III tumours and MGMT methylation. In this group cognitive functioning is significantly better in the domains of immediate recall, short delayed recall and delayed recall, and in the fields of executive functioning and recognition. There were no differences in cognitive functioning in regard to MGMT status. Grade III tumours were associated with more frequent MGMT methylation. Self-assessment proved week tool, associated only with immediate recall. We found no differences in cognitive functioning according to MGMT status, but cognition was better when IDH mutation was present. In a cohort study of patients with high-grade glioma, almost half were unable to participate in a study, which points to an overrepresentation of patients with better cognitive functioning in the research.
Keywords: cognition, high grade glioma, IDH1 mutation
Published in DiRROS: 25.07.2024; Views: 299; Downloads: 111
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Keywords: colorectal cancer, liver metastasis, future liver remnant, posthepatectomy liver failure
Published in DiRROS: 25.07.2024; Views: 274; Downloads: 179
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Abstract: Background. The significance of nutritional care in the management of cancer, particularly in the surgical treatment of abdominal cancer, is increasingly acknowledged. Body composition analysis, such as the Bioelectric impedance assay (BIA), and functional tests, e.g., handgrip strength, are used when assessing nutritional status alongside general and nutritional history, clinical examination, and laboratory tests. The primary approach in nutritional care is individually adjusted nutritional counselling and the use of medical nutrition, especially oral nutritional supplements. The aim of the study was to investigate the effects of perioperative nutritional care on body composition and functional status in patients with carcinoma of the gastrointestinal tract, hepatobiliary system, and pancreas. Patients and methods. 47 patients were included, 27 received preoperative and postoperative nutritional counselling and oral nutritional supplements (Group 1), while 20, due to surgical or organisational reasons, received nutritional care only postoperatively (Group 2). The effect of nutritional therapy was measured with bioimpedance body composition and handgrip measurements. Results. Group 2 had a higher average Nutritional Risk Screening (NRS) 2002 score upon enrolment (3 vs. 2 points); however, there was no difference when malnutrition was assessed using Global Leadership in Malnutrition (GLIM) criteria. There was a relative increase in lean body mass and fat-free mass index (FFMI) 7 days after surgery in group 1 (+4,2% vs. -2,1% in group 2). There was no difference in handgrip strength. Conclusions. Our results indicate that combined preoperative and postoperative nutritional care is superior to only postoperative nutritional care. It seems to prevent statistically significant lean mass loss 7 days after surgery but not after 14 days or 4 weeks.
Keywords: abdominal cancer, nutritional status, body composition
Published in DiRROS: 25.07.2024; Views: 268; Downloads: 101
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