Negative mpMRI Rules Out Extra-Prostatic Extension in Prostate Cancer Before Robot-Assisted Radical Prostatectomy

The accuracy of multi-parametric MRI (mpMRI) in pre-operative staging of prostate cancer (PCa) remains controversial. Objective: To evaluate the ability of mpMRI to accurately predict PCa extra-prostatic extension (EPE) on a side-specific basis using a risk-stratified 5-point Likert scale. This study also aimed to assess the influence of mpMRI scan quality on diagnostic accuracy. Patients and Methods: We included 124 men who underwent robot-assisted RP (RARP) as part of the NeuroSAFE PROOF study at our centre. Three radiologists retrospectively reviewed mpMRI blinded to RP pathology and assigned a Likert score (1-5) for EPE on each side of the prostate. Each scan was also ascribed a Prostate Imaging Quality (PI-QUAL) score for assessing the quality of the mpMRI scan, where 1 represents poorest and 5 represents best diagnostic quality. Outcome measurements and statistical analyses: Diagnostic performance is presented for binary classification of EPE including 95% confidence intervals and area under the receiver operating characteristic curve (AUC). Results: A total of 231 lobes from 121 men (mean age 56.9 years) were evaluated. 39 men (32.2%), or 43 lobes (18.6%) had EPE. Likert score ≥3 had sensitivity (SE), specificity (SP), NPV, PPV of 90.4%, 52.3%, 96%, 29.9%, respectively, and AUC was 0.82 (95% CI: 0.77-0.86). AUC was 0.63 (95% CI: 0.37-0.9), 0.77 (0.71-0.84) and 0.92 (0.88-0.96) for biparametric scans, PI-QUAL 1-3 and PI-QUAL 4-5 scans, respectively. Conclusions: MRI can be used effectively by genitourinary radiologists to rule out EPE and help inform surgical planning for men undergoing RARP. EPE prediction was more reliable when the MRI scan was a) multi-parametric and b) of a higher image quality according to the PI-QUAL scoring system.

Early outcomes of robotic distal gastrectomy with D2 lymphadenectomy for gastric cancer at Binh Dan Hospital

Introduction: Gastric cancer is one of the five most common malignancies in Vietnam and worldwide. Recently, robotic gastrectomy with lymphadenectomy has become a new trend in the treatment of gastric cancer. In Vietnam, we conducted this study to assess the safety and feasibility of this procedure. Patients and methods: Descriptive study with a case series enrolled 13 patients with lower third gastric cancer underwent gastrectomy with lymphadenectomy by Si-generation da Vinci robot at Binh Dan Hospital from 01/01/2017 to 31/07/2019. Results: Male/female ratio was 2.25:1. The median age was 56.92 ± 8.66 years old. The pre-operative staging (cTNM) was mostly stage III. Robot docking time was 15 ± 7.36 minutes. The total operating time was 225.38 ± 36.43 minutes. The average blood loss during surgery was 66.15 ± 23.64 ml. There were no intraoperative accident as well as early postoperative complication. The postoperative hospital stay was 7.62 ± 0.87 days. The total number of metastatic lymph nodes was 1.62 ± 1.61 nodes. The postoperative staging was IIIA (53.85%), IIB (23.08%), IIA (15.38%) and IB (7.69%) respectively. Conclusions: Robotic gastrectomy is a safe procedure with promising indexes during and after surgery. Key word: Gastric cancer, robotic surgery. Tóm tắt Đặt vấn đề: Ung thư dạ dày (UTDD) là một trong năm loại ung thư phổ biến nhất tại Việt Nam và trên thế giới. Phẫu thuật robot cắt dạ dày và nạo hạch trở thành xu hướng điều trị mới trong UTDD. Tại Việt Nam, chúng tôi tiến hành nghiên cứu sau để tìm hiểu tính an toàn và khả thi của phương pháp phẫu thuật này. Đối tượng và phương pháp nghiên cứu: Nghiên cứu mô tả hàng loạt ca: 13 trường hợp ung thư dạ dày 1/3 dưới được phẫu thuật bằng robot da Vinci thế hệ Si tại bệnh viện Bình Dân từ 01/01/2017 đến 31/7/2019. Kết quả: Tỉ lệ nam : nữ là 2,25 : 1. Độ tuổi trung bình là 56,92 ± 8,66 tuổi. Giai đoạn bệnh trước mổ (cTNM) đa số là giai đoạn III. Thời gian docking robot là 15 ± 7,36 phút. Thời gian mổ toàn bộ là 225,38 ± 36,43 phút. Lượng máu mất trong mổ là 66,15 ± 23,64 ml. Tỉ lệ tai biến và biến chứng sớm là 0%. Thời gian nằm viện sau mổ là 7,62 ngày ± 0,87 ngày. Tổng số hạch di căn là 1,62 ± 1,61 hạch. Giai đoạn bệnh sau mổ bao gồm IIIA (53,85%), IIB (23,08%), IIA (15,38%), IB (7,69%). Kết luận: Phẫu thuật bằng robot cắt dạ dày là một phương pháp phẫu thuật an toàn với các chỉ số trong mổ và sau mổ đầy khả quan. Từ khóa: Phẫu thuật robot, ung thư dạ dày.

Cholesterolosis of the gall bladder: a surgical dilemma

Cholesterolosis of the gall bladder or cholesterol polyps of the gall bladder have always been a contentious issue with respect to the role of prophylactic surgery in view of its asymptomatic state. Symptomatic cholesterol polyps behave similar to gall stones. There is therefore a need for a surgical algorithm to manage these lesions. A case of symptomatic cholesterol polyps of the gall bladder is reported to highlight the clinical presentation, imaging modalities and management strategies. Symptomatic cholesterol polyps of the gall bladder necessitate cholecystectomy. However, surgical intervention for asymptomatic polyps is guided by their size. Increased diameter is highly suspicious of a malignant potential requiring pre-operative staging and radical surgery.

Neutrophil-lymphocyte ratio and platelet-lymphocyte ratios correlate with staging in patients with colorectal carcinoma

Background: Systemic inflammation status is revealed to be associated with prognosis of solid tumours. Inflammatory markers including C-reactive protein, Neutrophil-lymphocyte ratio and platelet-lymphocyte ratio have been claimed to provide insight into resectability of carcinoma and in predicting prognosis. The objective of this study was to study neutrophil lymphocyte ratio and platelet lymphocyte ratio profiles in patients with colo-rectal cancers.Methods: This study was done as a hospital based descriptive on 80 patients diagnosed with colonic and rectal cancers. The study was carried out from May 2017 to May 2018 at General Surgery and Radiotherapy departments at Government Medical College, Trivandrum. Neutrophil lymphocyte ratio and platelet lymphocyte ratio was calculated and correlated with the pre-operative staging, post-operative staging and the histopathological grade.Results: Both neutrophil lymphocyte ratio and platelet lymphocyte ratio were found to be higher in patients with colo-rectal cancers as compared to values in normal healthy population. Neutrophil lymphocyte ratio was well correlated with tumour status, nodal status and overall stage in pathological staging. Platelet lymphocyte ratio was well correlated with tumour status and overall stage in CT staging and with tumour status, nodal status and overall stage in pathological staging.Conclusions: Neutrophil lymphocyte ratio and platelet lymphocyte ratio are correlated with colo-rectal carcinomas and may provide valuable information in staging the patients. They are cost-effective, easily measurable but affected by race, sex, age, co-morbidities and many other potential factors. Routine estimation of these ratios can serve as adjunct to staging as well as help to prognosticate the patients.