Points essentiels Les options therapeutiques recommandees pour traiter les cancers de prostate de... more Points essentiels Les options therapeutiques recommandees pour traiter les cancers de prostate de bas risque sont la surveillance active, les traitements radicaux ou l’abstention surveillance. Les therapies focales sont en cours d’evaluation pour le traitement des cancers de prostate de bas risque. Les patients peuvent etre traites par ces options therapeutiques dans le cadre de protocole de recherche, ou concernant la cryotherapie et l’HIFU en dehors des recommandations. Les resultats oncologiques de ces traitements focaux sont encourageants et presentent une excellente tolerance avec peu de complications. Les therapies focales n’empechent pas la realisation de traitements radicaux en cas d’echec. Les therapies focales sont une solution possible au probleme de sur-traitement des cancers de prostate de bas risque.
Presse medicale (Paris, France : 1983), Jan 11, 2017
Multiparametric MRI prostate (mp-MRI) is a powerful tool to locate lesions>0.5cm(3) (below thi... more Multiparametric MRI prostate (mp-MRI) is a powerful tool to locate lesions>0.5cm(3) (below this threshold tumor volume, prostate cancers are classified as "insignificant"). The detection rate of the mp-MRI for significant cancers of small volume (0.5-1cm(3)) with a Gleason score≥7 is>85 %. The prostate mp-MRI optimizes the management of cancers classified as low risk of progression by providing aggressive criteria for misclassified lesions, which require an active treatment and enhance the clinicopathological criteria of indolence for subclinical lesions, which can justify of surveillance. MRI-mp coupled to the 3D ultrasound image fusion, optimizes the predictive value of biopsies and improves tumor staging, particularly when benign prostatic hyperplasia (>40cm(3)) is associated with clinical course. New tissue markers feasible on biopsies allow to define better the risk of progression of the small volume of cancer in order to reinforce the indications of surveill...
Presse medicale (Paris, France : 1983), Jan 11, 2017
Recommended options for low-risk prostate cancer treatment are active surveillance, radical treat... more Recommended options for low-risk prostate cancer treatment are active surveillance, radical treatments or watchful waiting. Focal therapies are currently assessed for low risk prostate cancer treatment. Focal therapies can be performed in research protocols. Oncologic results of these focal treatments are encouraging and show excellent tolerance with few complications. Radical treatments are still possible after focal therapies failure. Focal therapies are a possible solution to over-treatment issue of low risk prostate cancers.
514 Background: The aim of this study was to assess the veracity of the outcomes from renal biops... more 514 Background: The aim of this study was to assess the veracity of the outcomes from renal biopsy performed under CT-scan control for patients harboring cT1a stage tumors. Methods: In a retrospective study, we analyzed the outcomes of renal biopsies performed under CT-scan control for patients harboring tumors under 4 cm. Pathology has been compared between biopsy sample and nephrectomy specimen. Every patient included had a small renal mass (cT1a) and had to undergo a CT-scan guided renal biopsy before nephron sparing or enlarged nephrectomy (that had to be done within 6 months after the biopsy). Results: From January 2007 to December 2012, we performed 79 CT-scan guided renal biopsies. Among these patients, biopsy lead to the diagnosis of the renal lesion for 70 cases. For 9 cases, biopsy was not contributive. Following the biopsy, 19 patients underwent a nephron sparing surgery and 10 a radical nephrectomy. Comparison of the pathological outcomes between biopsy and surgical spec...
539 Background: Assess CT-scan guided renal biopsies relevance in the management of small renal m... more 539 Background: Assess CT-scan guided renal biopsies relevance in the management of small renal masses. Methods: Retrospective analysis from 01/2007 to 12/2012 of percutaneous CT-scan guided renal biopsies performed at our institution for patients harboring renal tumors. Exclusion criteria were presence of metastasis and/or >4cm tumors. Data analyzed were pathological outcomes, management of the tumors and complications from the procedure during the 30 days post-biopsies. Results: 119 patients underwent a renal biopsy during this period. 79 presented the selection criteria. Renal biopsies lead to a diagnosis in 70 cases (88.6%) and were non contributive in 9 cases (11.4%). Among contributive biopsies, there were 46 (66%) cases of cancer and 24 cases (34%) of benign tumors. During follow-up, 2 (2.5%) patients presented Clavien-Dindo grade I-II complications: 1 acute urinary retention and 1 subfebrile lumbar pain. Conclusions: The yield of CT-scan guided renal biopsies to define pa...
To evaluate our experience in patients undergoing hybrid transvaginal NOTES nephrectomy and evalu... more To evaluate our experience in patients undergoing hybrid transvaginal NOTES nephrectomy and evaluate the sexual functions in the post-operative period. Prospective data of 71 patients with renal tumors who underwent hybrid NOTES radical nephrectomy in three different centers were collected from March 2010 to October 2015. Patient and surgical characteristics are recorded. Sexual function was evaluated with Female Sexual Function Index (FSFI) questionnaire, the day prior to the operation and three months after. The mean age, tumor size and operation duration were 66.16±11.21, 8.51±3.31 cm and 119.94±21.38 minutes, respectively. Five patients were immediately re-operated due to bleeding from uterine veins. The complication risk increases significantly with increasing tumor size. Among the whole cohort, even the FSFI score differences are small; there is a statistically significant decrease in the postoperative period in all domains except sexual satisfaction. In fact, the patients reported unaltered sexual function after surgery and satisfaction with the result when asked directly. In subgroup analyses, in nulliparous patients (n=60), arousal, sexual desire, orgasm and satisfaction domains have no significant differences in pre- and post-operative periods. Hybrid NOTES nephrectomy is a feasible, safe operation that can be performed for large renal tumors. Due to incisions in the vaginal wall for specimen retrieval, sexual function can be altered in the post-operative period. So, patient selection, pre-operative evaluation, and close follow-up are mandatory. With this in mind, we strongly support the use of hybrid transvaginal NOTES nephrectomy for large renal tumors especially in nulliparous patients.
Data Revues 00904295 V78i3ss S0090429511011058, Oct 14, 2011
nary tact (UUT-UCC) are often invasive tumors. They are mainly diagnosed in the workup because of... more nary tact (UUT-UCC) are often invasive tumors. They are mainly diagnosed in the workup because of hematuria and/or lumbar pain. There are no clear data of the difference in clinical symptoms, diagnosis and treatment according to the history of previous bladder cancer (BC) in UUT-UCC. We present an evaluation of the differences in patients with UUT-UCC according to the past history of BC on different aspects in the diagnosis and management of these patients. Material and Methods: This is a retrospective analysis of 931 patients diagnosed and treated of UUT-UCC in a Spanish Collaborative group in UUT-UUC from 1950 to 2010. They all underwent cystoscopyϩ/Ϫ TURBT and were treated because of the presence of an UTT-UCC. We analyse according to BC (no tumour, previous, concomitant or both) the following variables: age, sex, location of the tumour in the upper tract, multifocality, clinical symptoms, tumor grade, pathological stage and surgical treatment. Contingency tables and chi-square test were used for categorical variables and analysis of variance (ANOVA) for quantitative variables. Results: Of 931 patients, including 80.9% males, 25.8% had previous BC, 15.5% concomitant and 3.2% both, with a mean age of 65.5 ϩ/Ϫ 20. Women had less past history of BC (pϭ0.001). In the different groups of tpatients with BC there was not a difference in stage or grade but CIS was more often present in concomitant tumours (pϭ0.02). Those patients with bladder cancer were older ((pϭ0.02) and had: more tumours located in the distal ureter (pϭ0.001), more multiple upper tract tumours (pϽ0.001), multiple loca
RESULTS: Endoscopy of the ileal loop as well as the upper urinary tract allowed us to make a hist... more RESULTS: Endoscopy of the ileal loop as well as the upper urinary tract allowed us to make a histological mapping in order to decide further treatment. CONCLUSIONS: Tumor recurrence of multicentric transitional cell carcinoma associated with carcinoma in situ is common and in patients who underwent cystectomy is difficult to assess whether there is evidence of papillary formations. The endoscopic management of patients with suspected recurrence is a safe and effective option that allows taking biopsies under direct vision and mapping the upper urinary tract, reaching inadvertent injury to the common imaging tests.
Points essentiels Les options therapeutiques recommandees pour traiter les cancers de prostate de... more Points essentiels Les options therapeutiques recommandees pour traiter les cancers de prostate de bas risque sont la surveillance active, les traitements radicaux ou l’abstention surveillance. Les therapies focales sont en cours d’evaluation pour le traitement des cancers de prostate de bas risque. Les patients peuvent etre traites par ces options therapeutiques dans le cadre de protocole de recherche, ou concernant la cryotherapie et l’HIFU en dehors des recommandations. Les resultats oncologiques de ces traitements focaux sont encourageants et presentent une excellente tolerance avec peu de complications. Les therapies focales n’empechent pas la realisation de traitements radicaux en cas d’echec. Les therapies focales sont une solution possible au probleme de sur-traitement des cancers de prostate de bas risque.
Presse medicale (Paris, France : 1983), Jan 11, 2017
Multiparametric MRI prostate (mp-MRI) is a powerful tool to locate lesions>0.5cm(3) (below thi... more Multiparametric MRI prostate (mp-MRI) is a powerful tool to locate lesions>0.5cm(3) (below this threshold tumor volume, prostate cancers are classified as "insignificant"). The detection rate of the mp-MRI for significant cancers of small volume (0.5-1cm(3)) with a Gleason score≥7 is>85 %. The prostate mp-MRI optimizes the management of cancers classified as low risk of progression by providing aggressive criteria for misclassified lesions, which require an active treatment and enhance the clinicopathological criteria of indolence for subclinical lesions, which can justify of surveillance. MRI-mp coupled to the 3D ultrasound image fusion, optimizes the predictive value of biopsies and improves tumor staging, particularly when benign prostatic hyperplasia (>40cm(3)) is associated with clinical course. New tissue markers feasible on biopsies allow to define better the risk of progression of the small volume of cancer in order to reinforce the indications of surveill...
Presse medicale (Paris, France : 1983), Jan 11, 2017
Recommended options for low-risk prostate cancer treatment are active surveillance, radical treat... more Recommended options for low-risk prostate cancer treatment are active surveillance, radical treatments or watchful waiting. Focal therapies are currently assessed for low risk prostate cancer treatment. Focal therapies can be performed in research protocols. Oncologic results of these focal treatments are encouraging and show excellent tolerance with few complications. Radical treatments are still possible after focal therapies failure. Focal therapies are a possible solution to over-treatment issue of low risk prostate cancers.
514 Background: The aim of this study was to assess the veracity of the outcomes from renal biops... more 514 Background: The aim of this study was to assess the veracity of the outcomes from renal biopsy performed under CT-scan control for patients harboring cT1a stage tumors. Methods: In a retrospective study, we analyzed the outcomes of renal biopsies performed under CT-scan control for patients harboring tumors under 4 cm. Pathology has been compared between biopsy sample and nephrectomy specimen. Every patient included had a small renal mass (cT1a) and had to undergo a CT-scan guided renal biopsy before nephron sparing or enlarged nephrectomy (that had to be done within 6 months after the biopsy). Results: From January 2007 to December 2012, we performed 79 CT-scan guided renal biopsies. Among these patients, biopsy lead to the diagnosis of the renal lesion for 70 cases. For 9 cases, biopsy was not contributive. Following the biopsy, 19 patients underwent a nephron sparing surgery and 10 a radical nephrectomy. Comparison of the pathological outcomes between biopsy and surgical spec...
539 Background: Assess CT-scan guided renal biopsies relevance in the management of small renal m... more 539 Background: Assess CT-scan guided renal biopsies relevance in the management of small renal masses. Methods: Retrospective analysis from 01/2007 to 12/2012 of percutaneous CT-scan guided renal biopsies performed at our institution for patients harboring renal tumors. Exclusion criteria were presence of metastasis and/or >4cm tumors. Data analyzed were pathological outcomes, management of the tumors and complications from the procedure during the 30 days post-biopsies. Results: 119 patients underwent a renal biopsy during this period. 79 presented the selection criteria. Renal biopsies lead to a diagnosis in 70 cases (88.6%) and were non contributive in 9 cases (11.4%). Among contributive biopsies, there were 46 (66%) cases of cancer and 24 cases (34%) of benign tumors. During follow-up, 2 (2.5%) patients presented Clavien-Dindo grade I-II complications: 1 acute urinary retention and 1 subfebrile lumbar pain. Conclusions: The yield of CT-scan guided renal biopsies to define pa...
To evaluate our experience in patients undergoing hybrid transvaginal NOTES nephrectomy and evalu... more To evaluate our experience in patients undergoing hybrid transvaginal NOTES nephrectomy and evaluate the sexual functions in the post-operative period. Prospective data of 71 patients with renal tumors who underwent hybrid NOTES radical nephrectomy in three different centers were collected from March 2010 to October 2015. Patient and surgical characteristics are recorded. Sexual function was evaluated with Female Sexual Function Index (FSFI) questionnaire, the day prior to the operation and three months after. The mean age, tumor size and operation duration were 66.16±11.21, 8.51±3.31 cm and 119.94±21.38 minutes, respectively. Five patients were immediately re-operated due to bleeding from uterine veins. The complication risk increases significantly with increasing tumor size. Among the whole cohort, even the FSFI score differences are small; there is a statistically significant decrease in the postoperative period in all domains except sexual satisfaction. In fact, the patients reported unaltered sexual function after surgery and satisfaction with the result when asked directly. In subgroup analyses, in nulliparous patients (n=60), arousal, sexual desire, orgasm and satisfaction domains have no significant differences in pre- and post-operative periods. Hybrid NOTES nephrectomy is a feasible, safe operation that can be performed for large renal tumors. Due to incisions in the vaginal wall for specimen retrieval, sexual function can be altered in the post-operative period. So, patient selection, pre-operative evaluation, and close follow-up are mandatory. With this in mind, we strongly support the use of hybrid transvaginal NOTES nephrectomy for large renal tumors especially in nulliparous patients.
Data Revues 00904295 V78i3ss S0090429511011058, Oct 14, 2011
nary tact (UUT-UCC) are often invasive tumors. They are mainly diagnosed in the workup because of... more nary tact (UUT-UCC) are often invasive tumors. They are mainly diagnosed in the workup because of hematuria and/or lumbar pain. There are no clear data of the difference in clinical symptoms, diagnosis and treatment according to the history of previous bladder cancer (BC) in UUT-UCC. We present an evaluation of the differences in patients with UUT-UCC according to the past history of BC on different aspects in the diagnosis and management of these patients. Material and Methods: This is a retrospective analysis of 931 patients diagnosed and treated of UUT-UCC in a Spanish Collaborative group in UUT-UUC from 1950 to 2010. They all underwent cystoscopyϩ/Ϫ TURBT and were treated because of the presence of an UTT-UCC. We analyse according to BC (no tumour, previous, concomitant or both) the following variables: age, sex, location of the tumour in the upper tract, multifocality, clinical symptoms, tumor grade, pathological stage and surgical treatment. Contingency tables and chi-square test were used for categorical variables and analysis of variance (ANOVA) for quantitative variables. Results: Of 931 patients, including 80.9% males, 25.8% had previous BC, 15.5% concomitant and 3.2% both, with a mean age of 65.5 ϩ/Ϫ 20. Women had less past history of BC (pϭ0.001). In the different groups of tpatients with BC there was not a difference in stage or grade but CIS was more often present in concomitant tumours (pϭ0.02). Those patients with bladder cancer were older ((pϭ0.02) and had: more tumours located in the distal ureter (pϭ0.001), more multiple upper tract tumours (pϽ0.001), multiple loca
RESULTS: Endoscopy of the ileal loop as well as the upper urinary tract allowed us to make a hist... more RESULTS: Endoscopy of the ileal loop as well as the upper urinary tract allowed us to make a histological mapping in order to decide further treatment. CONCLUSIONS: Tumor recurrence of multicentric transitional cell carcinoma associated with carcinoma in situ is common and in patients who underwent cystectomy is difficult to assess whether there is evidence of papillary formations. The endoscopic management of patients with suspected recurrence is a safe and effective option that allows taking biopsies under direct vision and mapping the upper urinary tract, reaching inadvertent injury to the common imaging tests.
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Papers by Luca Lunelli