LAPAROSCOPY/NEW TECHNOLOGY
849
importantly 4 drug related deaths were observed. Nonetheless, the authors suggest that further investigation is warranted, given the suggestion of disease activity. Samir S. Taneja, MD
Suggested Reading Hadaschik B, Su Y, Huter E et al: Antigen specific T-cell responses against tumor antigens are controlled by regulatory T cells in patients with prostate cancer. J Urol 2012; 187: 1458.
Laparoscopy/New Technology Re: Retzius-Sparing Robot-Assisted Laparoscopic Radical Prostatectomy: Combining the Best of Retropubic and Perineal Approaches S. K. Lim, K. H. Kim, T. Y. Shin, W. K. Han, B. H. Chung, S. J. Hong, Y. D. Choi and K. H. Rha Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea, and Department of Urology, Changi General Hospital, Singapore BJU Int 2014; 114: 236e244.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2014.12.009 available at http://jurology.com/ Editorial Comment: The authors reproduce the technique first reported by Galfano et al in 2010.1 This procedure essentially involves antegrade robotic perineal prostatectomy wherein the space of Retzius is never entered, the dorsal venous complex is never transected and the endopelvic fascia is left intact. The purported advantage would be better short-term urinary continence and less blood loss. A total of 50 patients undergoing this retrovesical, antegrade approach were compared retrospectively to more than 500 patients who underwent conventional robotic prostatectomy. The authors found no difference in hospital stay, blood loss, complications or positive margins. Surgeon console times were shorter, and recovery of early continence (at 4 weeks) was significantly better than the entire open cohort and even a matched pair cohort. However, the authors acknowledge that this approach is technically more demanding, and I question widespread adoption beyond a few experienced centers. Nevertheless, we should all be aware that robotic prostatectomy is an evolving surgical technique as we all strive to minimize morbidity. Jeffrey A. Cadeddu, MD 1. Galfano A, Ascione A, Grimaldi S et al: A new anatomic approach for robot-assisted laparoscopic prostatectomy: a feasibility study for completely intrafascial surgery. Eur Urol 2010; 58: 457.
Re: Detecting Positive Surgical Margins Using Single Optical Fiber Probe during Radical Prostatectomy: A Pilot Study M. Baykara, T. Denkc¸eken, I. Bassorgun, Y. Akin, S. Yucel and M. Canpolat Departments of Urology and Pathology, and Biomedical Optics Research Unit, Department of Biophysics, Faculty of Medicine, Akdeniz University, Antalya and Department of Urology, Faculty of Medicine, Erzincan University, Erzincan, Turkey Urology 2014; 83: 1438e1442.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2014.12.010 available at http://jurology.com/ Editorial Comment: I have highlighted in this section previously the use of optical spectroscopy to enhance surgeon understanding of tissues beyond what we can see and to identify malignant vs benign tissue. This pilot study of 18 radical prostatectomy specimens is one of the few to apply
850
TESTIS CANCER AND ADVANCES IN ONCOLOGIC THERAPY
the technology to a practical question, ie detection of positive margins on the prostate specimen. The authors used a white light technique they call elastic light single-scattering spectroscopy, which can detect morphological differences in tissue structure. Although the surface area that can be evaluated is limited by the current 100 micron fiber size, the system was able to differentiate between benign and malignant margins with a sensitivity of 86% and a specificity of 97%. While this procedure is currently performed on the ex vivo prostate specimen, I can envision this technology being redesigned into a robotic/laparoscopic probe that can assess larger surface areas in real time, potentially enhancing the oncologic outcomes of the surgery. Jeffrey A. Cadeddu, MD
Urological Oncology: Testis Cancer and Advances in Oncologic Therapy Re: First Salvage Treatment in Patients with Advanced Germ Cell Cancer after Cisplatin-Based Chemotherapy: Analysis of a Registry of the German Testicular Cancer Study Group (GTCSG) L. A. Berger, C. Bokemeyer, A. Lorch, M. Hentrich, H. G. Kopp, T. C. Gauler, J. Beyer, M. de Wit, F. Mayer, I. Boehlke, C. Oing, F. Honecker and K. Oechsle Department of Oncology, Hematology and Bone Marrow Transplantation, and Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany J Cancer Res Clin Oncol 2014; 140: 1211e1220.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2014.12.049 available at http://jurology.com/ Editorial Comment: Metastatic germ cell cancer has become highly curable with the advent of cisplatin based combination chemotherapy. Unfortunately 20% to 30% of patients do not achieve full remission with first-line chemotherapy. The authors studied 143 patients at 9 centers with relapsed or refractory germ cell tumor undergoing salvage treatment with either conventional dose or high dose chemotherapy with autologous stem cell support. They used the prognostic subgroups of the International Prognostic Factors Study Group (IPFSG), which categorizes patients into very low risk, intermediate risk, high risk and very high risk groups. The IPFSG category significantly correlated with overall survival after first salvage treatment. This study confirms the prognostic value of the IPFSG prognostic score. Based on this retrospective analysis, high dose chemotherapy with stem cell support seems superior to conventional dose chemotherapy. Jerome P. Richie, MD
849
importantly 4 drug related deaths were observed. Nonetheless, the authors suggest that further investigation is warranted, given the suggestion of disease activity. Samir S. Taneja, MD
Suggested Reading Hadaschik B, Su Y, Huter E et al: Antigen specific T-cell responses against tumor antigens are controlled by regulatory T cells in patients with prostate cancer. J Urol 2012; 187: 1458.
Laparoscopy/New Technology Re: Retzius-Sparing Robot-Assisted Laparoscopic Radical Prostatectomy: Combining the Best of Retropubic and Perineal Approaches S. K. Lim, K. H. Kim, T. Y. Shin, W. K. Han, B. H. Chung, S. J. Hong, Y. D. Choi and K. H. Rha Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea, and Department of Urology, Changi General Hospital, Singapore BJU Int 2014; 114: 236e244.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2014.12.009 available at http://jurology.com/ Editorial Comment: The authors reproduce the technique first reported by Galfano et al in 2010.1 This procedure essentially involves antegrade robotic perineal prostatectomy wherein the space of Retzius is never entered, the dorsal venous complex is never transected and the endopelvic fascia is left intact. The purported advantage would be better short-term urinary continence and less blood loss. A total of 50 patients undergoing this retrovesical, antegrade approach were compared retrospectively to more than 500 patients who underwent conventional robotic prostatectomy. The authors found no difference in hospital stay, blood loss, complications or positive margins. Surgeon console times were shorter, and recovery of early continence (at 4 weeks) was significantly better than the entire open cohort and even a matched pair cohort. However, the authors acknowledge that this approach is technically more demanding, and I question widespread adoption beyond a few experienced centers. Nevertheless, we should all be aware that robotic prostatectomy is an evolving surgical technique as we all strive to minimize morbidity. Jeffrey A. Cadeddu, MD 1. Galfano A, Ascione A, Grimaldi S et al: A new anatomic approach for robot-assisted laparoscopic prostatectomy: a feasibility study for completely intrafascial surgery. Eur Urol 2010; 58: 457.
Re: Detecting Positive Surgical Margins Using Single Optical Fiber Probe during Radical Prostatectomy: A Pilot Study M. Baykara, T. Denkc¸eken, I. Bassorgun, Y. Akin, S. Yucel and M. Canpolat Departments of Urology and Pathology, and Biomedical Optics Research Unit, Department of Biophysics, Faculty of Medicine, Akdeniz University, Antalya and Department of Urology, Faculty of Medicine, Erzincan University, Erzincan, Turkey Urology 2014; 83: 1438e1442.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2014.12.010 available at http://jurology.com/ Editorial Comment: I have highlighted in this section previously the use of optical spectroscopy to enhance surgeon understanding of tissues beyond what we can see and to identify malignant vs benign tissue. This pilot study of 18 radical prostatectomy specimens is one of the few to apply
850
TESTIS CANCER AND ADVANCES IN ONCOLOGIC THERAPY
the technology to a practical question, ie detection of positive margins on the prostate specimen. The authors used a white light technique they call elastic light single-scattering spectroscopy, which can detect morphological differences in tissue structure. Although the surface area that can be evaluated is limited by the current 100 micron fiber size, the system was able to differentiate between benign and malignant margins with a sensitivity of 86% and a specificity of 97%. While this procedure is currently performed on the ex vivo prostate specimen, I can envision this technology being redesigned into a robotic/laparoscopic probe that can assess larger surface areas in real time, potentially enhancing the oncologic outcomes of the surgery. Jeffrey A. Cadeddu, MD
Urological Oncology: Testis Cancer and Advances in Oncologic Therapy Re: First Salvage Treatment in Patients with Advanced Germ Cell Cancer after Cisplatin-Based Chemotherapy: Analysis of a Registry of the German Testicular Cancer Study Group (GTCSG) L. A. Berger, C. Bokemeyer, A. Lorch, M. Hentrich, H. G. Kopp, T. C. Gauler, J. Beyer, M. de Wit, F. Mayer, I. Boehlke, C. Oing, F. Honecker and K. Oechsle Department of Oncology, Hematology and Bone Marrow Transplantation, and Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany J Cancer Res Clin Oncol 2014; 140: 1211e1220.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2014.12.049 available at http://jurology.com/ Editorial Comment: Metastatic germ cell cancer has become highly curable with the advent of cisplatin based combination chemotherapy. Unfortunately 20% to 30% of patients do not achieve full remission with first-line chemotherapy. The authors studied 143 patients at 9 centers with relapsed or refractory germ cell tumor undergoing salvage treatment with either conventional dose or high dose chemotherapy with autologous stem cell support. They used the prognostic subgroups of the International Prognostic Factors Study Group (IPFSG), which categorizes patients into very low risk, intermediate risk, high risk and very high risk groups. The IPFSG category significantly correlated with overall survival after first salvage treatment. This study confirms the prognostic value of the IPFSG prognostic score. Based on this retrospective analysis, high dose chemotherapy with stem cell support seems superior to conventional dose chemotherapy. Jerome P. Richie, MD
![[Positive surgical margins after radical prostatectomy].](/assets/img/hold.png)
