Save and preserve: it is the new ‘must’ of urological surgery in oncology, bringing excellent results from the point of view of efficacy and safety. In fact, conservative surgery is on the rise, that set of treatments – mainly managed with robots – that aim to save the organ or gland affected by the neoplasm, instead of removing it. Every year in Italy about 40% of patients with urological oncological pathology, who until a few years ago had to undergo interventions that involved the removal of an organ (prostate, kidney or bladder) today can benefit from approaches whose objective main is to better contrast the disease, while safeguarding those physiological functions that most strongly involve the patient’s quality of life: from continence to the ability to erect and ejaculate. It was discussed at the 93rd National Congress of the Siu, the Italian Society of Urology, in Rome.
Today, cancers of the prostate, kidneys and bladder provide valid alternatives to radical surgery. From focal ultrasound therapy for the prostate, to ‘trimodal’ therapy (chemotherapy, radiotherapy and endoscopic resection) dedicated to the bladder, we then move on to the great role of robotics and its rapid development over the last 10 years. In the case of prostate cancer, a targeted treatment that does not involve its removal, in fact, is focal therapy with the use of high-intensity ultrasound: “It seems to have satisfactory oncological results, without leading to functional impairment – notes Francesco Porpiglia, Professor of Urology at the University of Turin and Head of the Scientific Office of the Siu – It is carried out using a dedicated transrectal ultrasound probe, capable of emitting special ultrasounds that cause the death of cancer cells. The postoperative hospital stay is 24-48 hours and the side effects in terms of irritative or obstructive symptoms (weak jet or urge urination) are minimal. No problems are found on erection and ejaculation. Cancer specific survival can reach 99% at 5 years of follow-up”.
Conservative surgery is also increasingly being considered for kidney cancer: “Today 70% of patients with tumor confined to the kidney can benefit from this type of surgery – adds Walter Artibani, secretary general of Siu – In particular, thanks to robotics, the direct approach to safeguarding the organ can also be proposed in case of complex tumor masses to be removed. This is because maintaining valid renal function (in terms of creatinine) is also essential to increase the overall survival of the population. The balance between oncological safety and functional advantage is currently at the center of a wide debate especially among experienced surgeons: despite being technically able to remove the bulky tumor or very difficult to eliminate, they are faced with the doubt whether to preserve the organ. is a fairer solution than a more radical intervention”.
Video: Di Bartolo (AMD): “Today, therapies can change the history of type 2 diabetes” (Adnkronos)
Doctors, strengthen wards and resuscitations, missing 6ml
Maneuver allocates funds but an extraordinary plan is needed for the Order
Medicine entrance test, Tortorella (Consulcesi): “Unreliable. You need selection at the university “
(Agenzia Vista) Rome, October 15 Medicine entrance test, Tortorella (Consulcesi): “Unreliable. We need selection at the university ”“ The access system to the medical faculties with limited numbers has shown shortcomings and unreliability. We should go back to the right locations for the selection and that is to universities. It is necessary to give the possibility to those who want to enroll in Medicine or Dentistry to enroll in the faculty. The selection process must be done during the studies. An academic system is also necessary that adapts to the needs of doctors in the National Health Service ”are the words of the lawyer Marco Tortorella of Consulcesi. Source: Vista Agency / Alexander Jakhnagiev Agenziavista.it
Covid-19: French doctors and nurses in the streets, “We are collapsing”
French healthcare is a crisis not because there are too many sick people, but because there are few staff and few beds. This is the thought that dominates among the hundreds of doctors and nurses who took to the streets on Thursday. “We are tired, we are about to collapse”, says one of the protesters. The protests, in the capital and in other French cities, concern the lack of recruitment, the grueling shifts, low wages and inadequate facilities. Problems that have worsened with the outbreak of the Covid-19 pandemic. “It’s terrible. There is a lack of people and means everywhere, we work in deplorable conditions”, declares a demonstrator. In July, the government and some unions had signed an agreement that provided for the arrival of seven and a half billion euros to finance the increase in the salaries of nurses, an average of 183 euros more in paychecks. However, this is not enough for the demonstrators. “My body has abandoned me. I need to get my head back. I’ve seen colleagues get sick … We hear the government say: ‘Get back to the front lines, we have faith in you. Well, I won’t be there, ‘says a worker. In France, infections have reached 850,997, 33,146 have been dead since the beginning of the emergency, according to Johns Hopkins University. To try to stop the virus and avoid creating chaos in hospitals, the government has imposed a curfew from 9pm to 6am in Paris and other centers, starting on Saturday. “The problem this time around is that the epidemic will happen in the winter, when we normally have large numbers of patients who are hospitalized for chronic respiratory or heart disease, seasonal viruses or flu. In the months of December, January and February, the beds are all occupied, regardless of Covid-19”, says Bruno Megarbane, who heads the intensive care of the Laribosière hospital in Paris. France is the second most affected country by the coronavirus in the European Union, after Spain. Many healthcare workers fear they will not be able to cope with the brunt of the second wave of the pandemic.
Analogous discourse for the treatment of muscle invasive bladder cancer: “”Beside the solution that today constitutes the first choice, that is the removal of the bladder with urinary derivation, today a new multidisciplinary approach is gaining ground between urologist, radiologist and oncologist who, for selected patients (for example with comorbidities that do not radical surgery is possible and all patients strongly motivated to preserve the bladder), certainly constitutes a promising alternative – observes Porpiglia – It is the so-called ‘trimodal’ therapy, which combining the advantages of chemotherapy, radiotherapy and endoscopic resection of the bladder tumor , allows to control the tumor without the need to remove the organ with obvious benefits for the patient’s quality of life. With this type of approach, the 5-year cancer specific survival is 65%. The key element for the good efficacy of the treatment – he adds – is the radical nature of the endoscopic resection of the tumor alone (without removal of the bladder), which varies the complete response rate from 57% to 79%. The advantages? It allows to obtain good oncological results, preserves physiological urination and ensures a good quality of life for the patient because it maintains erections, ejaculations and fertility”.
At the heart of this new conservative surgery is the great technological evolution that took place with the advent of robotic surgery (which offers the surgeon the possibility of ‘seeing in 3D’, guaranteeing ever finer and more precise movements) and the introduction of new platforms for minimally invasive treatments. This together with the increasing request from patients to be able to preserve their physiological functions in terms of urination and sexual capacity; have strongly pushed third millennium surgery in this direction.
In the field of prostate cancer, thanks to ‘precision surgery’, which aims to preserve continence and postoperative power as much as possible, robotics makes it possible to guarantee a postoperative continence rate already in the immediate vicinity of over 70 %, and 95% at three months; while about 60% of patients can benefit from a preservation of the nerves responsible for erection “with a resumption of erectile function at 3 months of more than 60%, which goes up to almost 90% one year after surgery in young patients – concludes Porpiglia – In addition, the introduction of new ways of viewing the tumor, such as ” use of 3D images and augmented reality, allow to maximize oncological results even in the case of locally advanced disease”.