- Email: [email protected]
Laparoscopic transperitoneal adrenalectomy: 9 year experience
P2
33 LOW
FREQIJENCE
OF
LOCUS IN LOCALIZED
ALTERATIONS
PROSTATE
AT
THE
P27
GENE
KIPl
CANCER
Machtens Stefan. Kuczyk Markus, Serth Juergen, Herrmann Roland. Schwede Joern, Jonas Udo Urology, Hannover Medical School. Hatmover. Germany INTRODUCTION & OBJECTIVES: p27 Kipl has been identified as the mo\t important regulator of the activity of the cyclin kinase cdk2. which has pivotal influence on the regulation of the cell cycle at the Cl-checkpoint. As recent investigations of our group have identified the loss of p27 Kipl protein expression as predictor of recurrence free survival in patients with localised prostate cancer after radical prostatectomy, we now intended to identify alterations at the p27 Kipl gene locus and the p27mRNA respectively. MATERIAL & METHODS: Using microdissection approximately IOO- 1000 tumour cells from 39 tumour specimens after radical prostatectomy were isolated. After incubation in 20~1 proteinase K digestion puffer, the cells were incubated at 5OoC for 3Ominutes. For amplification of the first PCR-product by semi-nested PCR. two primers, which bind to the upper part of exon I (p27XAU) and the lower part of exon2 (p27X2L) of the p27Kipl gene were used. PCR was carried out for 35 cycles. The PCR products were analysed by direct DNA sequencing by the use of a “thermo sequence radiolabeled terminator cycle sequencing kit”. RESULTS: In 4 of 39 examined prostate cancers a G-T transversion in codon I09 was identified, which resulted in the generation of a new restriction site. Missense point mutations were identified in 2 of 39 turnouts. They were localised in codon 77 and S9. Both patients with proven point mutations demonstrated a negative immunohistochemical reaction. CONCLUSIONS: Aa in other human malignancies the frequence of p27Kip I gene mutations appear to be a rather rare event. Therefore the immunohistochemical described loss of p27 protein expression appears to be the result of posttranslational events. Considering the lack of molecular alterations at the p27Kipl gene locus, investigations concerning the relevance of p27Kipl should be carried out with techniques analysing the protein product like immunohistochemistry.
ADRENALS AND KIDNEYTfWW'lANTATlON
Sunday,February 24,11.45-13.15 hrs,RoomB
ADRENAL
GLAND
DISEASE:
STUDY
Garcia Cristobal', Roasino Antonio’, Manjon Capitan’ . Leiva Oscar’ ‘Urology, I2 de Octubre Hospital, Poniente (El Ejido). Almeria, Spain
34
OF I35 CASES Vazquea
Madrid.
Salvador’.
Tejido
Spain. ‘Urology.
AND FAMILIAL Jeschke Klaus’, Henning Klaus’
PARTIAL
ADRENALECTOMY
FOR
ADENOMA
PHEOCHROMOCYTOMA Peschel Reinhard’.
Zussner
‘Urology, General Hospital Klagenfurt, University Innsbruck, Innsbruck,Austria
Friedrich’.
Klagenfurt,
Bartsch
Austria.
Georg’,
LUrology,
INTRODUCTION & OBJECTIVES: Laparoscopy has to be seen as standard in adrenal surgery, and so laparoscopic adrenalectomy is a common procedure. In benigne deseases, such as adenomas or familial pheochromocytomaa, partial adrenalectomy is a reasonable choice, as they may occur on both tides simultaneously as well as consecutively. We report our experience with laparoscopic partial adrenalectomy in such patients.
MATERIAL
& METHODS: In our 2 centres in I5 patients with adrenal adenoma or familial pheochromocytoma partial adrenalectomies have been performed between 611992 and 912001. Average age was 41 (2 I-7 I ) years. average tumour size 3,6 (2-7) cm. Each, the right and the left side. were affected in 6 patients. bilateral turnouts were found m 3 patients. The transperitoneal approach was used in all patients, hemostasis was achieved by bipolar coagulation and finally the cut surface was sealed with fibrin glue. RESULTS: All procedures could be completed as planned, and there was no need for conversion to open surgery. Average operating time was I35 min and blood loss 78 ml. No major intraoperative or postoperative complication occurred. Histologic examination showed an adenoma in 9 and a phcochromocytoma in 6 cases. Poatoperativc CT scans found normal blood supply of the remaining adrenal tissue and blood pressure readings and catecholamine levels were unremarkable at follow up. None of the patients required steroid replacement therapy. CONCLUSIONS: Partial adrenalectomy in selected patients with adrenal adenomas or familial pheochromocytomas is a well-tolerated and minimally invasive procedure with a low complication rate. We would recommend it for patients with bilateral disease or small tumours that involve only a certain part of the gland.
Hospital
de
INTRODUCTION & OBJECTIVES: Due to the anatomic location of the with adrenal eland, urologists should be familiar the clinical, pathophysrological, diagnostic, and therapeutic features of this organ. The objectives of the present study were: 1) Review our series of patients with adrenal processes. 2) Analyse the performance of imaging techniques and laboratory studies. 3) Review our diagnostic-therapeutic protocols. 4) Evaluate surgical approaches and their results and complications. 5) Analyse survival in relation to the clinical syndromes and histological types.
MATERIAL
& METHODS: Between January 1974 and June 2000, 146 adrenal syndromes and/or turnouts were diagnosed and/or treated in our service. Fourteen patients were excluded from this descriptive retrospective study, leaving I35 valid cases for study. RESULTS: Adrenal tumbrel disease was more frequent in women (56.3%, 761135) than in men (43.7%). The clinical syndromes observed in this series were pheochromocytoma 37.74 (5 l/135), non-functioning turnouts 32% (43/135), Cushing’s syndrome 23.7% (32/135), and hyperaldosteronism I I .80/r (161135). No case of virilization syndrome was observed. A histological diagnosis was reached in I23 patients. Chromaffn turnouts were the most frequent type 34.1% (39 pheochromocytomaa, 1 neuroblastoma and 2 ganglioneuromas). Among the nonchromaffin turnouts, the most frequent was adenoma 33.3% (41/123), followed by metastatic carcinoma IO.69 (131123). The most commonly used surgical approaches were lumbotomy 43. I o/r (531123) and laparotomy 39.8% (49/123). The presence of primary and metaatatic carcinoma influenced survival. We describe our current diagnostic and therapeutic protocols and discuss the performance of imaging and laboratory techniques (Fig.]).
35 LAPAROSCOPIC
Angel’.
36 LAPAROSCOPIC EXPERIENCE
TRANSPERITONEAL
ADRENALECTOMY:
Cestari Andrea, Guazzoni Giorgio. Bellinzoni Broglia Luigi, Riva Matteo, Rigatti Patrizio
Piera. Centemero
9 YEAR
Antonella,
Urology. San Raffaele Hospital, Milan. Italy INTRODUCTION & OBJECTIVES: Laparoscopic adrenalectomy has become the technique of choice for removal of benign adrenal lesions. Various laparoscopic techniques and approaches have been reported, with a transperitoneal or retroperitoneal route. We present our nine-year experience and long term results with transperitoneal laparoscopic adrenal surgery.
MATERIAL
& METHODS: Between October 1992 and September 200 I, I84 laparoscopic approaches to the adrenal gland have been performed, namely I63 unilateral adrenalectomy (69 right, 94 left) for the following pathologies: 56 Conn’s disease. 38 Cushing’s disease, 34 Pheochromocytoma, 29 non functioning adenomas and 6 malignancy: IS bilateral adrenalectomy and 7 cases of conservative surgery. The patients were placed in a ho-degree flank position with the bed flexed to increase the surgical field; the first step of the intervention was the early ligation of the main adrenal vein. to avoid hypertensive crisis, especially in patients with pheochromocytoma. RESULTS: The laparoscopic procedure was successfully completed in all but 4 cases, which were turned into open surgery. Mean operative time was IS4 min in the unilateral group, 240 min in the bilateral group and 85 min in the conservative group. Delayed complications included: 3 cases of hemoperitoneum which were drained surgically, 3 cases of severe blood loss which were treated with blood transfusions, 2 cases of wound infection. Patients were able to ambulate on the morning of the first post operative day and were discharged respectively after 2.7, 5 and I .S days after surgery in the unilateral, bilateral and conservative group. CONCLUSIONS: Laparoscopic transperitoneal adrenalectomy is a safe and effective. minimally invasive approach for patients with benign functioning or non functioning adrenal masses. This technique has low morbidity. minimal postoperative analgesic requirements and short hospital stay.
European Urology Supplements 1 (2002)No. 1, pp. 11
33 LOW
FREQIJENCE
OF
LOCUS IN LOCALIZED
ALTERATIONS
PROSTATE
AT
THE
P27
GENE
KIPl
CANCER
Machtens Stefan. Kuczyk Markus, Serth Juergen, Herrmann Roland. Schwede Joern, Jonas Udo Urology, Hannover Medical School. Hatmover. Germany INTRODUCTION & OBJECTIVES: p27 Kipl has been identified as the mo\t important regulator of the activity of the cyclin kinase cdk2. which has pivotal influence on the regulation of the cell cycle at the Cl-checkpoint. As recent investigations of our group have identified the loss of p27 Kipl protein expression as predictor of recurrence free survival in patients with localised prostate cancer after radical prostatectomy, we now intended to identify alterations at the p27 Kipl gene locus and the p27mRNA respectively. MATERIAL & METHODS: Using microdissection approximately IOO- 1000 tumour cells from 39 tumour specimens after radical prostatectomy were isolated. After incubation in 20~1 proteinase K digestion puffer, the cells were incubated at 5OoC for 3Ominutes. For amplification of the first PCR-product by semi-nested PCR. two primers, which bind to the upper part of exon I (p27XAU) and the lower part of exon2 (p27X2L) of the p27Kipl gene were used. PCR was carried out for 35 cycles. The PCR products were analysed by direct DNA sequencing by the use of a “thermo sequence radiolabeled terminator cycle sequencing kit”. RESULTS: In 4 of 39 examined prostate cancers a G-T transversion in codon I09 was identified, which resulted in the generation of a new restriction site. Missense point mutations were identified in 2 of 39 turnouts. They were localised in codon 77 and S9. Both patients with proven point mutations demonstrated a negative immunohistochemical reaction. CONCLUSIONS: Aa in other human malignancies the frequence of p27Kip I gene mutations appear to be a rather rare event. Therefore the immunohistochemical described loss of p27 protein expression appears to be the result of posttranslational events. Considering the lack of molecular alterations at the p27Kipl gene locus, investigations concerning the relevance of p27Kipl should be carried out with techniques analysing the protein product like immunohistochemistry.
ADRENALS AND KIDNEYTfWW'lANTATlON
Sunday,February 24,11.45-13.15 hrs,RoomB
ADRENAL
GLAND
DISEASE:
STUDY
Garcia Cristobal', Roasino Antonio’, Manjon Capitan’ . Leiva Oscar’ ‘Urology, I2 de Octubre Hospital, Poniente (El Ejido). Almeria, Spain
34
OF I35 CASES Vazquea
Madrid.
Salvador’.
Tejido
Spain. ‘Urology.
AND FAMILIAL Jeschke Klaus’, Henning Klaus’
PARTIAL
ADRENALECTOMY
FOR
ADENOMA
PHEOCHROMOCYTOMA Peschel Reinhard’.
Zussner
‘Urology, General Hospital Klagenfurt, University Innsbruck, Innsbruck,Austria
Friedrich’.
Klagenfurt,
Bartsch
Austria.
Georg’,
LUrology,
INTRODUCTION & OBJECTIVES: Laparoscopy has to be seen as standard in adrenal surgery, and so laparoscopic adrenalectomy is a common procedure. In benigne deseases, such as adenomas or familial pheochromocytomaa, partial adrenalectomy is a reasonable choice, as they may occur on both tides simultaneously as well as consecutively. We report our experience with laparoscopic partial adrenalectomy in such patients.
MATERIAL
& METHODS: In our 2 centres in I5 patients with adrenal adenoma or familial pheochromocytoma partial adrenalectomies have been performed between 611992 and 912001. Average age was 41 (2 I-7 I ) years. average tumour size 3,6 (2-7) cm. Each, the right and the left side. were affected in 6 patients. bilateral turnouts were found m 3 patients. The transperitoneal approach was used in all patients, hemostasis was achieved by bipolar coagulation and finally the cut surface was sealed with fibrin glue. RESULTS: All procedures could be completed as planned, and there was no need for conversion to open surgery. Average operating time was I35 min and blood loss 78 ml. No major intraoperative or postoperative complication occurred. Histologic examination showed an adenoma in 9 and a phcochromocytoma in 6 cases. Poatoperativc CT scans found normal blood supply of the remaining adrenal tissue and blood pressure readings and catecholamine levels were unremarkable at follow up. None of the patients required steroid replacement therapy. CONCLUSIONS: Partial adrenalectomy in selected patients with adrenal adenomas or familial pheochromocytomas is a well-tolerated and minimally invasive procedure with a low complication rate. We would recommend it for patients with bilateral disease or small tumours that involve only a certain part of the gland.
Hospital
de
INTRODUCTION & OBJECTIVES: Due to the anatomic location of the with adrenal eland, urologists should be familiar the clinical, pathophysrological, diagnostic, and therapeutic features of this organ. The objectives of the present study were: 1) Review our series of patients with adrenal processes. 2) Analyse the performance of imaging techniques and laboratory studies. 3) Review our diagnostic-therapeutic protocols. 4) Evaluate surgical approaches and their results and complications. 5) Analyse survival in relation to the clinical syndromes and histological types.
MATERIAL
& METHODS: Between January 1974 and June 2000, 146 adrenal syndromes and/or turnouts were diagnosed and/or treated in our service. Fourteen patients were excluded from this descriptive retrospective study, leaving I35 valid cases for study. RESULTS: Adrenal tumbrel disease was more frequent in women (56.3%, 761135) than in men (43.7%). The clinical syndromes observed in this series were pheochromocytoma 37.74 (5 l/135), non-functioning turnouts 32% (43/135), Cushing’s syndrome 23.7% (32/135), and hyperaldosteronism I I .80/r (161135). No case of virilization syndrome was observed. A histological diagnosis was reached in I23 patients. Chromaffn turnouts were the most frequent type 34.1% (39 pheochromocytomaa, 1 neuroblastoma and 2 ganglioneuromas). Among the nonchromaffin turnouts, the most frequent was adenoma 33.3% (41/123), followed by metastatic carcinoma IO.69 (131123). The most commonly used surgical approaches were lumbotomy 43. I o/r (531123) and laparotomy 39.8% (49/123). The presence of primary and metaatatic carcinoma influenced survival. We describe our current diagnostic and therapeutic protocols and discuss the performance of imaging and laboratory techniques (Fig.]).
35 LAPAROSCOPIC
Angel’.
36 LAPAROSCOPIC EXPERIENCE
TRANSPERITONEAL
ADRENALECTOMY:
Cestari Andrea, Guazzoni Giorgio. Bellinzoni Broglia Luigi, Riva Matteo, Rigatti Patrizio
Piera. Centemero
9 YEAR
Antonella,
Urology. San Raffaele Hospital, Milan. Italy INTRODUCTION & OBJECTIVES: Laparoscopic adrenalectomy has become the technique of choice for removal of benign adrenal lesions. Various laparoscopic techniques and approaches have been reported, with a transperitoneal or retroperitoneal route. We present our nine-year experience and long term results with transperitoneal laparoscopic adrenal surgery.
MATERIAL
& METHODS: Between October 1992 and September 200 I, I84 laparoscopic approaches to the adrenal gland have been performed, namely I63 unilateral adrenalectomy (69 right, 94 left) for the following pathologies: 56 Conn’s disease. 38 Cushing’s disease, 34 Pheochromocytoma, 29 non functioning adenomas and 6 malignancy: IS bilateral adrenalectomy and 7 cases of conservative surgery. The patients were placed in a ho-degree flank position with the bed flexed to increase the surgical field; the first step of the intervention was the early ligation of the main adrenal vein. to avoid hypertensive crisis, especially in patients with pheochromocytoma. RESULTS: The laparoscopic procedure was successfully completed in all but 4 cases, which were turned into open surgery. Mean operative time was IS4 min in the unilateral group, 240 min in the bilateral group and 85 min in the conservative group. Delayed complications included: 3 cases of hemoperitoneum which were drained surgically, 3 cases of severe blood loss which were treated with blood transfusions, 2 cases of wound infection. Patients were able to ambulate on the morning of the first post operative day and were discharged respectively after 2.7, 5 and I .S days after surgery in the unilateral, bilateral and conservative group. CONCLUSIONS: Laparoscopic transperitoneal adrenalectomy is a safe and effective. minimally invasive approach for patients with benign functioning or non functioning adrenal masses. This technique has low morbidity. minimal postoperative analgesic requirements and short hospital stay.
European Urology Supplements 1 (2002)No. 1, pp. 11