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Introduction: Surgical treatment of post-chemotherapy residual mass of germ cell tumor (GCT) may be performed in various techniques. We assess the feasibility, safety, and efficacy of single-docking with lateral approach robot-assisted retroperitoneal lymph node dissection (R-RPLND) in residual mass of GCT in our center.Materials and methods: A retrospective review of patients undergoing R-RPLND for residual mass of CGT was performed between January 2014 and April 2017. Patients with residual mass < 3 cm for seminoma or < 1 cm for non-seminoma were eligible. All surgeries were performed with single-docking RPNLD technique in lateral decubitus. We assessed preoperative characteristics (age, testicular pathology, template, chemotherapy regimen, lesion size, and clinical stage), peroperative (operative time, estimated blood loss, intraoperative complication, node count, pathology, and number of positive node), and postoperative outcomes (postoperative complications, hospital length of stay, recurrence-free survival at 2 year, and ejaculation dysfunction).Results: Eleven patients underwent R-RPLND with a median size of the residual mass of 20 mm. Median operative time was 153 min with 120 ml of estimated blood loss, without intraoperative complication. Median nodes count was 7 [1; 24]. Two patients had post-chemotherapy necrotic nodes and one no tumorous node. One patient had postoperative Clavien I complication (chyloperitoneum). We report 72.7% of antegrade ejaculation at 1 month from the surgery. Median clinical recurrence-free survival was 100% after 2 years from the surgery (n = 6).Conclusion: Lateral approach with single-docking R-RPLND for residual mass of GCT is feasible and safe, with satisfying functional and oncologic outcomes. [ABSTRACT FROM AUTHOR]

We compared the outcomes of robotic-assisted partial nephrectomy (RPN) and open partial nephrectomy (OPN) using contemporary data to respond to unmet clinical needs. Data from patients included in the registry who underwent partial nephrectomy between January 01, 2014 and June 30, 2017 within 20 centres of the French Network for Research on Kidney Cancer UroCCR were collected (NCT03293563). Statistical methods included adjusted multivariable analyses. Rates of peri- and post-operative transfusion, and of surgical revision, were lower in the RPN (n = 1434) than the OPN (n = 571) group (2.9% vs. 6.0%, p = 0.0012; 3.8% vs. 11.5%, p < 0.0001; 2.4% vs. 6.7%, p < 0.0001, respectively). In multivariable analyses, RPN was independently associated with fewer early post-operative complications than OPN (overall: odds-ratio [95% confidence interval, CI] = 0.48 [0.35–0.66]; severe: 0.29 [0.16–0.54], p < 0.0001 for both) and shorter hospital stays (34% [30%; 37%], p < 0.0001). RPN was also a significantly associated with a decresedrisk of post-operative acute renal failure, and new-onset chronic kidney disease at 3 and 12 months post-surgery. There were no between-group differences in oncological outcomes. In comparison with OPN, RPN was associated with improved peri- and post-operative morbidity, better functional outcomes, and shorter hospital stays. Our results support the use of RPN, even for large and complex tumours. [ABSTRACT FROM AUTHOR]

La prise en charge des cancers de la prostate à haut risque a fortement évolué ces dernières années. Les progrès de l'imagerie permettent de mieux définir l'agressivité réelle de la maladie, de planifier le geste chirurgical, et d'améliorer l'évaluation pronostique de ces maladies à haut risque de récidive. Les informations obtenues par l'IRM et par les biopsies ciblées améliorent la prise en charge en amont de la chirurgie. Les progrès de la médecine nucléaire et la généralisation des TEP-scanographie au prostate-specific membrane antigen (PSMA) commencent à bouleverser l'étape initiale diagnostique, et améliorent la détection des métastases ganglionnaires et à distance. L'intérêt oncologique de ces nouvelles imageries, qui influencent ensuite le plan thérapeutique, reste à définir. L'impact curatif d'un curage ganglionnaire étendu, comme recommandé à l'heure actuelle, reste à prouver et les essais randomisés récemment publiés ne permettent pas de conclure. Les nouvelles hormonothérapies ouvrent la voie à une intensification du traitement systémique périopératoire, avec une action réelle sur le tissu tumoral, mais un impact en survie qui reste à définir dans le cadre d'essais randomisés en cours. The management of high-risk prostate cancer has greatly evolved in recent years. Advances in imaging helps to better define the actual aggressiveness of the disease, to plan the surgical procedure, and to improve the prognostic evaluation of this high-risk of recurrence disease. The information obtained by MRI and by targeted biopsies improves management before surgery. Advances in nuclear medicine and generalization of PSMA-PET scans are beginning to improve the initial stage of diagnosis, thanks to a better detection of lymph node and distant metastases. The oncological interest of these new imaging techniques, which then influence the therapeutic plan, remains to be defined. The curative impact of an extensive lymph node dissection, as currently recommended, remains to be proved, and recently published randomized trials do not provide firm conclusions. The new hormone therapies pave the way for an intensification of perioperative systemic treatment, with a significant action on the tumor tissue, but an impact on survival, which remains to be defined in the context of ongoing randomized trials. [ABSTRACT FROM AUTHOR]

Purpose: Ileal orthotopic neobladder (IONB) reconstruction is the preferred urinary diversion among selected patients who have undergone radical cystectomy (RC) for bladder cancer (BCa). There is insufficient data regarding patients' quality of life (QoL), sexual and urinary outcomes. Our objectives were to assess QoL in a multicentre cohort study, and to identify related clinical, oncological and functional factors. Methods: Patients who underwent RC with IONB reconstruction for BCa from 2010 to 2017 at one of the three French hospitals completed the following self-reported questionnaires: European Organization for Research and Treatment of Cancer (EORTC) generic (QLQ-C30) and bladder cancer specific instruments (QLQ-BLM30). To assess urinary symptoms, patients completed the Urinary Symptom Profile questionnaire (USP) and a three-day voiding diary. Univariate and multivariate analyses were computed to identify clinical, pathological, and functional predictors of global QoL score. Results: Seventy-three patients completed questionnaires. The median age was 64 years and 86.3% were men. The median interval between surgery and responses to questionnaires was 36 months (range 12–96). Fifty-five percent of patients presented a high global QoL (EORTC-QLQC30, median score 75). A pre-RC American Society of Anesthesiologists score > 2, active neoplasia, sexual inactivity, and stress urinary incontinence were associated with a worse QoL. After a multivariate analysis, sexual inactivity was the only independent factor related to an altered QoL. Conclusion: Patients with IONB reconstruction after RC have a high global QoL. Sexual activity could independently impact the global QoL, and it should be assessed pre- and post-operatively by urologists. [ABSTRACT FROM AUTHOR]

Purpose: To compare perioperative and functional outcomes of two different energy sources, holmium laser and bipolar current for endoscopic enucleation of prostate larger than 60 mL. Methods: A prospective, monocentric, comparative, non-randomized study was conducted including all patients treated for prostate larger than 60 mL, measured by transrectal ultrasound. Patients were assigned to each group based on the surgeons' practice. Perioperative data were collected (preoperative characteristics, operating, catheterization and hospitalization times, hemoglobin loss, complications) and functional outcomes (IPSS, IPSS Quality of Life (QoL), PSA) at 3 months and 1 year. Results: 100 patients were included in each group from October 2015 to March 2018. No differences between HoLEP and plasma groups were observed at baseline, except for mean IPSS score, IPSS QoL score and preoperative PVR that were significantly higher in the HoLEP group. Operating time (142.1 vs 122.4 min; p = 0.01), catheterization time (59.6 vs 44.4 h; p = 0.01) and hospitalization time (2.5 vs 1.8 days; p = 0.02) were significantly shorter in the plasma group. Complication and transfusion rate were no significantly different between HoLEP and plasma. No significant differences were observed concerning functional outcomes at 3 months and 1 year. The urinary incontinence rate was higher 21.1% vs 6.4% (p < 0.01) at 3 months in HoLEP group, but no difference was observed at 1 year. Conclusion: Holmium and plasma are both safe and effective for endoscopic treatment for prostate larger than 60 mL. Operating, catheterization and hospitalization times were significantly shorter in the plasma group. The complication rate and functional outcomes were not significantly different. [ABSTRACT FROM AUTHOR]

BACKGROUND: Cytoreductive nephrectomy has been the standard of care in metastatic renal-cell carcinoma for 20 years, supported by randomized trials and large, retrospective studies. However, the efficacy of targeted therapies has challenged this standard. We assessed the role of nephrectomy in patients with metastatic renal-cell carcinoma who were receiving targeted therapies. METHODS: In this phase 3 trial, we randomly assigned, in a 1:1 ratio, patients with confirmed metastatic clear-cell renal-cell carcinoma at presentation who were suitable candidates for nephrectomy to undergo nephrectomy and then receive sunitinib (standard therapy) or to receive sunitinib alone. Randomization was stratified according to prognostic risk (intermediate or poor) in the Memorial Sloan Kettering Cancer Center prognostic model. Patients received sunitinib at a dose of 50 mg daily in cycles of 28 days on and 14 days off every 6 weeks. The primary end point was overall survival. RESULTS: A total of 450 patients were enrolled from September 2009 to September 2017. At this planned interim analysis, the median follow-up was 50.9 months, with 326 deaths observed. The results in the sunitinib-alone group were noninferior to those in the nephrectomy-sunitinib group with regard to overall survival (stratified hazard ratio for death, 0.89; 95% confidence interval, 0.71 to 1.10; upper boundary of the 95% confidence interval for noninferiority, =1.20). The median overall survival was 18.4 months in the sunitinib-alone group and 13.9 months in the nephrectomy-sunitinib group. No significant differences in response rate or progression-free survival were observed. Adverse events were as anticipated in each group. CONCLUSIONS: Sunitinib alone was not inferior to nephrectomy followed by sunitinib in patients with metastatic renal-cell carcinoma who were classified as having intermediaterisk or poor-risk disease. (Funded by Assistance Publique-Hôpitaux de Paris and others. [ABSTRACT FROM AUTHOR]

Résumé Le cancer de la prostate, le plus fréquent des cancers chez l’homme, est un adénocarcinome sensible, dans plus de 80 % des cas, à la castration chimique, en raison de son hormonodépendance. L’hormonothérapie androgénosuppressive est le traitement des formes évoluées du cancer et peut être associée à la radiothérapie en évoluée. Le choix thérapeutique, pluridisciplinaire, est fondé sur l’âge et les maladies associées du patient, et le stade clinique. L’impact de l’hormonothérapie confère au patient des effets secondaires variés et ceux cardiovasculaires sont maintenant mieux connus. Les mécanismes responsables de cette cardiotoxicité sont à la fois directs et indirects par effets métaboliques thermogéniques. L’analyse de ces effets cliniques ou biologiques, leurs corrélations au type d’hormonothérapie utilisé et les précautions possibles de prescription seront détaillés dans cette synthèse de la littérature. La collaboration du cancérologue ou de l’urologue avec le cardiologue devient nécessaire et l’existence d’une unité d’oncocardiologie pourrait améliorer l’évaluation de la balance bénéfice–risque et la tolérance du traitement. Prostate cancer, the most frequent cancer in man, is an adenocarcinoma sensible to chemical castration in more than 80% of cases due to its hormonal dependency. Androgen deprivation is the treatment for advanced cancer and can be associated with radiotherapy locally or in locally advanced situations. Multidisciplinary therapeutic choice depends on patient age and co-morbidities and clinical stage. The impact of hormonal treatment confers varied side effects and cardiovascular effects are now better known. Responsible mechanisms of this cardiotoxicity are at the same time direct but also indirect by metabolic thermogenic effects. Analysis of these clinical or biological effects, their correlations to the used type of hormonal treatment and the possible precautions of prescription will be detailed in this analysis of the literature. The collaboration of the oncologist or the urologist with the cardiologist becomes necessary and the existence of a unit of oncocardiology could improve the evaluation of the risk–benefit balance and the tolerance of the treatment. [ABSTRACT FROM AUTHOR]