Objective:Robot-assisted partial nephrectomy(RAPN)has become widely used for treatment of renal cell carcinoma and it is expanding in the field of complex renal masses.The aim of this systematic review was to analyze ...Objective:Robot-assisted partial nephrectomy(RAPN)has become widely used for treatment of renal cell carcinoma and it is expanding in the field of complex renal masses.The aim of this systematic review was to analyze outcomes of RAPN for completely endophytic renal masses,large tumors(cT2-T3),renal cell carcinoma in solitary kidney,recurrent tumors,completely endophytic and hilar masses,and simultaneous and multiple tumors.Methods:A comprehensive search in the PubMed,Scopus,Web of Science,and Cochrane Central Register of Controlled Trials databases was performed in December 2022 for English language papers.The primary endpoint was to evaluate the role of RAPN in the setting of each category of complex renal masses considered.The secondary endpoint was to evaluate the surgical and functional outcomes.Results:After screening 1250 records,43 full-text manuscripts were selected,comprising over 8500 patients.Twelve and thirteen studies reported data for endophytic and hilar renal masses,respectively.Five and three studies reported outcomes for cT2-T3 and solitary kidney patients,respectively.Four studies focused on redo-RAPN for recurrent tumors.Two studies investigated simultaneous bilateral renal masses and five reports focused on multiple tumor excision in ipsilateral kidney.Conclusion:Over the past decade,evidence supporting the use of RAPN for the most challenging nephron-sparing surgery indications has continuously grown.Although limitations remain including study design and lack of detailed long-term functional and oncological outcomes,the adoption of RAPN for the included advanced indications is associated with favorable surgical outcomes with good preservation of renal function without compromising the oncological result.Certainly,a higher likelihood of complication might be expected when facing extremely challenging cases.However,none of these indications should be considered per se an exclusion criterion for performing RAPN.Ultimately,a risk-adapted approach should be employed.展开更多
文摘目的探讨^(99m)Tc-3PRGD2 SPECT/CT显像半定量参数对可疑乳腺病变的诊断价值,并根据乳腺癌分子分型进行分类比较,分析其与临床病理的相关性。方法收集2020年12月~2022年8月于我院接受检查的70例可疑乳腺病变患者病例资料。根据病理结果,分析乳腺癌Luminal阳性型、Her-2阳性型和三阴性型3种分子亚型与T/N值的相关性;分析雌激素受体、孕激素受体、Her-2及Ki67表达情况与影像学检查指标的关系。结果70例患者病理检查结果证实乳腺癌51例(72.86%),病理分型为Luminal阳性型22例,Her-2阳性型20例,三阴性型9例。乳腺良性病变24例(27.14%)。乳腺癌患者病变侧T/N值高于良性病变患者(3.96±0.82 vs 1.16±0.32),差异有统计学意义(t=14.426,P<0.05)。诊断特异性为84.21%(16/19),敏感度为82.35%(42/51),准确率为82.86%(58/70),ROC曲线下面积为0.834(0.755~0.913),诊断临界值为1.56,即T/N值≥1.56时判定为恶性病变。Her-2阳性型的T/N值高于三阴性型(P<0.05)。Her-2表达阳性患者的T/N值高于Her-2表达阴性的患者(P<0.05)。雌激素受体、孕激素受体和Ki67表达阳性和表达阴性患者的T/N值相比,差异均无统计学意义(P>0.05)。结论^(99m)Tc-3PRGD2 SPECT/CT显像半定量指标在诊断乳腺病变良恶性方面有较高的敏感度,并且Her-2阳性型患者T/N值明显升高,有助于早期发现和诊断乳腺病变,为预测乳腺癌分子分型和治疗有相应的指导作用。
文摘Objective:Robot-assisted partial nephrectomy(RAPN)has become widely used for treatment of renal cell carcinoma and it is expanding in the field of complex renal masses.The aim of this systematic review was to analyze outcomes of RAPN for completely endophytic renal masses,large tumors(cT2-T3),renal cell carcinoma in solitary kidney,recurrent tumors,completely endophytic and hilar masses,and simultaneous and multiple tumors.Methods:A comprehensive search in the PubMed,Scopus,Web of Science,and Cochrane Central Register of Controlled Trials databases was performed in December 2022 for English language papers.The primary endpoint was to evaluate the role of RAPN in the setting of each category of complex renal masses considered.The secondary endpoint was to evaluate the surgical and functional outcomes.Results:After screening 1250 records,43 full-text manuscripts were selected,comprising over 8500 patients.Twelve and thirteen studies reported data for endophytic and hilar renal masses,respectively.Five and three studies reported outcomes for cT2-T3 and solitary kidney patients,respectively.Four studies focused on redo-RAPN for recurrent tumors.Two studies investigated simultaneous bilateral renal masses and five reports focused on multiple tumor excision in ipsilateral kidney.Conclusion:Over the past decade,evidence supporting the use of RAPN for the most challenging nephron-sparing surgery indications has continuously grown.Although limitations remain including study design and lack of detailed long-term functional and oncological outcomes,the adoption of RAPN for the included advanced indications is associated with favorable surgical outcomes with good preservation of renal function without compromising the oncological result.Certainly,a higher likelihood of complication might be expected when facing extremely challenging cases.However,none of these indications should be considered per se an exclusion criterion for performing RAPN.Ultimately,a risk-adapted approach should be employed.
