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Laurent Salomon

Publications and source records attributed to Laurent Salomon.

At least 19 recordsLinked to original sources
PubMed2006

Renal cell carcinoma with nodal metastases in the absence of distant metastatic disease: prognostic indicators of disease-specific survival.

OBJECTIVES: Outcome of patients with exclusive renal cell carcinoma (RCC) nodal metastases without distant metastases is not extensively described. We explored the ability of standard risk factors such as tumour size, Fuhrman grade, histologic subtype and symptom classification to predict renal cell carcinoma-specific survival (RCC-SS). METHODS: Analyses targeted 171 patients with RCC nodal metastases and absence of distant metastases. Univariable, multivariable, and predictive accuracy analyses addressed RCC-SS with the intent of identifying independent and most informative predictors of RCC-SS in this cohort of patients. RESULTS: Median RCC-SS was 2.3 yr. Symptom classification (61.3%, p<0.001) demonstrated the highest univariable accuracy. In multivariable analyses, symptom classification contributed the most to the combined predictive accuracy of all variables (+4.2%, p<0.001), followed by Fuhrman grade (+2.3%) and histologic subtype (+1.0%). CONCLUSIONS: Renal cell carcinoma-specific survival of patients with exclusive nodal metastases may show important variability. In presence of systemic symptoms, survival is extremely poor. Substantially better survival may be expected in patients with local or no symptoms. This observation has important implications when adjuvant therapies are considered.

Adolescent↗
PubMed2006

Relationship between age at diagnosis and clinicopathologic features of renal cell carcinoma.

OBJECTIVES: To analyse the influence of age at diagnosis on tumour characteristics and cancer-specific survival in renal cell carcinoma (RCC). METHODS: Data on age, tumour characteristics, and survival for 4774 patients from 12 European RCC databases were recorded. Patients were divided into four groups according to age at diagnosis: < or =40, >40 and <60, > or =60 and <80, and > or =80 yr. The following variables were analysed: TNM stage, Fuhrman grade, tumour size, symptoms at diagnosis, ECOG performance status (PS), and cancer-specific survival. The groups were compared for usual clinical and pathologic variables, and cancer-specific survival. RESULTS: The four groups accounted for 288 (6%), 1839 (38.5%), 2499 (52.3%), and 148 cases (3.2%), respectively. Differences were found among groups for tumour stage, symptoms at diagnosis, ECOG PS, Fuhrman grade (p<0.001), tumour size, M stage, and histologic subtype (p: 0.02). Patients < or =40 yr were more likely to have papillary or chromophobe RCCs and less likely to have clear-cell RCCs. No significant difference was found among groups for N stage (p: 0.15). The 5-yr cancer-specific survival rates for the four age categories were 85%, 74%, 70%, and 69%, respectively. In multivariate analysis age category remained an independent prognostic parameter (p<0.001). CONCLUSIONS: Renal tumours diagnosed in younger age are characterized by lower tumour stages and grades as well as favourable histologic patterns compared with tumours in older patients. Basic research is required for explaining such a relationship between age, tumour aggressiveness, and therefore tumour biology.

Adult↗
PubMed2006

Adenocarcinoma of ileal neobladder 20 years after cystectomy.

We present the case of a 67-year-old man with adenocarcinoma of the ileal neobladder 20 years after radical cystoprostatectomy for Stage pT2 transitional bladder cell cancer. A MEDLINE research revealed 9 other cases of the development of a neoplasm in the ileal part of an ileocystoplasty. This observation supports the hypothesis that in an ileal neobladder morphologic and molecular changes can be observed similar to those in the development of colorectal carcinoma. Patients who had an ileal neobladder created are at risk of glandular malignancy and should be closely followed up.

Adenocarcinoma↗
PubMed2006

Saturation biopsy protocol enhances prediction of pT3 and surgical margin status on prostatectomy specimen.

A 21-samples saturation biopsy procedure (SBP) was developed in order to improve prostate cancer detection rate. Out of 650 patients who underwent this protocol, 150 had a clinically localized prostate cancer and underwent a radical prostatectomy. The number of cores positive for tumor was assessed in the SBP, and also in the sextant component of the SBP (SC) and in the non-sextant component of the SBP (NSC). Numbers of cores positive for tumor on SBP, SC, and NSC were significantly higher in pT3 group versus pT2 (P < 0.001 each) and in positive surgical margins (PSM) group versus no PSM (P < 0.001 each). When comparing area under the curve obtained from SBP with those obtained from NSC and SC, the SBP showed higher accuracy than the NSC and the SC for the prediction of pT3 and PSM. On multivariate analyses, SC and NSC were independent predictors of pT3 and PSM on radical prostatectomy.

Aged↗
PubMed2006

Characterization of ZAG protein expression in prostate cancer using a semi-automated microscope system.

OBJECTIVE: Zinc-alpha-2-glycoprotein 1 (ZAG) is a 41-kD secreted protein that is known to stimulate lipid degradation in adipocytes. The aim of this study was to determine how ZAG protein expression is associated with prostate cancer (PCa). MATERIALS AND METHODS: An immunohistochemistry analysis was performed on a 227 PCa tissue microarray cases. ZAG protein expression was assessed using a semi-automated cellular image analysis system. RESULTS: ZAG expression was associated with tumor stage (pT2 > pT3 > metastasis cases, P < 0.001), and was inversely associated with Gleason score on pathology (P = 0.01). ZAG intensity was predictive of biochemical recurrence (P = 0.002). On multivariate analysis including pT2 patients, the predictive factors of biochemical recurrence were ZAG expression (P = 0.016), Gleason score (P = 0.011), and surgical margin status (P = 0.047). CONCLUSIONS: This study characterized ZAG protein expression in PCa using a semi-automated system. ZAG expression level found to have an independent prognostic value for pT2 patients.

Adipokines↗
PubMed2006

Simulation training in video-assisted urologic surgery.

The current system of surgical education is facing many challenges in terms of time efficiency, costs, and patient safety. Training using simulation is an emerging area, mostly based on the experience of other high-risk professions like aviation. The goal of simulation-based training in surgery is to develop not only technical but team skills. This learning environment is stress-free and safe, allows standardization and tailoring of training, and also objectively evaluate performances. The development of simulation training is straightforward in endourology, since these procedures are video-assisted and the low degree of freedom of the instruments is easily replicated. On the other hand, these interventions necessitate a long learning curve, training in the operative room is especially costly and risky. Many models are already in use or under development in all fields of video-assisted urologic surgery: ureteroscopy, percutaneous surgery, transurethral resection of the prostate, and laparoscopy. Although bench models are essential, simulation increasingly benefits from the achievements and development of computer technology. Still in its infancy, virtual reality simulation will certainly belong to tomorrow's teaching tools.

Clinical Competence↗
PubMed2006

Laparoscopic radical prostatectomy in patients following transurethral resection of the prostate.

OBJECTIVES: Previous transurethral resection of the prostate (TURP) was reported to impose difficulties during open radical prostatectomy. We describe our experience in laparoscopic radical prostatectomy (LRP) following transurethral resection of the prostate. PATIENTS AND METHODS: The series included 35 patients: 22 patients underwent transperitoneal LRP (tpLRP) and 13 underwent extraperitoneal LRP (epLRP). The minimal interval between TURP and laparoscopy was 3 months. Patients' charts were reviewed for their preoperative characteristics, intraoperative difficulties and complications, and outcome. RESULTS: Patients' mean age was 67.5+/-4.4 years. 12 patients were cT1a,b and 23 patients were cT1c/T2. Twenty-two patients underwent tpLRP and 13 underwent epLRP. No statistical difference was found between the preoperative characteristics and the pathological results of cT1a,b vs. T1c/cT2 patients, or tpLRP vs. epLRP patients. Thirty-three procedures were completed laparoscopically and 2 were converted to open surgery. Perioperative complications included two leaking anastomoses, prolonged lymph drainage in 1 case, atelectasis (n=1) and duodenal ulcer (n=1). Twelve positive margins were noted, half of them in pT2 tumors. The mean follow-up was 28.5 months. Twenty-five of 35 patients had more than 12 months of follow-up. Among them 19 patients were completely continent (76%) and 6 (24%), reported mild stress incontinence. CONCLUSIONS: Although LRP following TURP is sometimes more technically difficult, simple modifications in the operative strategy help facilitate surgery. LRP following TURP favorably compares to open radical prostatectomy after TURP and laparoscopy in non-TURP patients.

Aged↗
PubMed2006

[Complications of retroperitoneal laparoscopy based on a series of 500 cases].

OBJECTIVE: To evaluate the complications of retroperitoneal laparoscopy for upper urinary tract surgery. METHODS: From 1994 to 2003, 500 retroperitoneal laparoscopy procedures were performed: 143 radical nephrectomies, 104 simple nephrectomies, 95 adrenalectomies, 47 ureteropelvic junction plasties, 44 partial nephrectomies, 22 nephroureterectomies, 20 cyst resections, 9 diverticulectomies, 8 lymphadenectomies, 4 pyelotomies and 4 ureteric procedures. The standardized technique uses 5 trocars. RESULTS: There were 23 conversions (4.60%): 5 for retroperitoneal adhesions, 11 for intraoperative bleeding, 7 for technical impossibility. 14 patients (2.8%) required surgical revision: 5 urinomas and 2 urocutaneous fistulas treated by ureteric drainage, 2 deep abscesses, 2 cases of secondary bleeding, 2 colostomies for gastrointestinal fistula after colonic injury, 1 incisional hernia on a trocar orifice. There were postoperative 2 deaths (0.4%) due to septic shock and haemorrhagic shock. 21 patients (4.2%) presented medical postoperative complications: haematoma, hyperthermia, phlebitis and pulmonary infections. 15 patients (3%) were transfused. The most frequent complications occurred after partial nephrectomies and the most serious complications occurred after radical nephrectomies. CONCLUSION: The complication rate is low. Retroperitoneal laparoscopy allows reproducible and effective upper urinary tract surgery, but it is not recommended in patients with a history of retroperitoneal surgery.

Adrenalectomy↗
PubMed2006

[Study of urothelial bladder tumours in renal transplant recipients].

OBJECTIVE: To study the prevalence, treatment and outcome of urothelial bladder tumours (UBT) in renal transplant recipients. PATIENTS AND METHODS: Multicentre retrospective study performed in 2004 by questionnaire sent to members of the AFU Transplantation Committee. RESULT: Seven centres returned the questionnaire with a total of 32 UBTs in 21 males and 3 females with a mean age of 63.2 +/- 10.1 years, with no history of UBT. The incidence was 255 per 100,000. The median interval between transplantation and UBT was 60 months (range: 5 to 259 months). 72% of UBTs were stage pT > or = 1 and 63% were grade 3. CIS was present in 20% of cases. 25% of patients were N+. In addition to resection of the UBT, 3 patients were also treated with mitomycin C and 1 was treated with BCG. 7 patients underwent cystectomy, with a palliative objective in 42% of cases, associated with radiotherapy-chemotherapy (2/3) or chemotherapy alone (1/3). Immunosuppressive therapy was decreased in 50% of cases. Six patients (25%) died from bladder cancer, 25% relapsed with a tumour progression rate of 50%. 46% of patients were in remission of their UBT 4% died from an intercurrent cause. 76% of survivors have a Junctional graft with no alteration of serum creatinine. CONCLUSION: Renal transplant recipients have an increased incidence of UBT, which are more aggressive and associated with a higher mortality compared to the general population. Increased surveillance and aggressive treatment therefore appear to be justified.

Female↗
PubMed2005

What information are urologists extracting from prostate needle biopsy reports and what do they need for clinical management of prostate cancer?

OBJECTIVES: This survey-based study examines what information urologists are extracting from prostate needle biopsy reports, and what they need for clinical management of prostate cancer (PC) patients. METHODS: A questionnaire was used to investigate several topics related to PC biopsy reporting. Two different clinical situations were separately explored, depending on whether the urologist intended a curative or a palliative therapy. RESULTS: 110 of the 300 (37%) urologists responded to the questionnaire and returned anonymous responses. The mean age of respondents was 47.5 years old (range 27-66). On average, they performed 31 (range 0-182) radical prostatectomies per year. Before proposing a curative therapy, several biopsy parameters were requested by the majority of respondents, including number of positive biopsies (104/110 or 95%), Gleason score (103/110 or 94%), highest Gleason grade (94/110 or 85%), localization of positive biopsies (80/110 or 73%), length of tumor on biopsy (58/110 or 53%), presence of extraprostatic extension (66/110 or 60%). In a palliative situation, only three parameters were requested by the majority of respondents: Gleason score (101/110 or 92%), highest Gleason grade (67/110 or 61%) and number of positive biopsies (59/110 or 54%). In prostate needle biopsies harboring cancer on multiple cores from separately designated locations, 77% (68/88) of respondents used the highest Gleason score, regardless of the overall percentage involvement, to determine their treatment plan. PIN (Prostatic Intraepithelial Neoplasia) on biopsy without PC was considered sufficient to re-biopsy by 77% (85/110) of respondents. Thirty six percent (40/110) of the respondents considered ASAP (Atypical Small Acinar Proliferation) to be equivalent to PIN. There was no significant association between the demographic data and the type of information requested on the biopsy report. CONCLUSIONS: In this sample of 110 French and Belgian urologists there was high variability in the way clinicians use prostate needle biopsy pathology report. Results of this survey should improve communication between urologists and pathologists and should help evaluate what data should be included in routine pathology reports.

Adult↗
PubMed2005

Suppression of radiative losses of surface polaritons on nanostructured thin metal films.

The strong electromagnetic coupling between surface plasmon polariton modes on opposite interfaces of a finite thickness periodically nanostructured metal film has been studied. Surface polariton dispersion and associated electromagnetic field distributions have been analyzed. It was shown that at a frequency that corresponds to the crossing of film Bloch modes of different symmetries, the radiative losses of surface polaritons that are related to the polaritons' coupling to light during propagation on the structured surface are suppressed.

Journal Article↗
PubMed2005

Skill assessment of urological laparoscopic surgeons: can criterion levels of surgical performance be determined using the pelvic box trainer?

OBJECTIVES: To correlate between surgeons' experience in urological laparoscopy and their performance of a set of laparoscopic tasks performed on a box trainer in the laparoscopic laboratory. METHODS: 44 urologists participated in this study. A self-administrated questionnaire enquired about their experience in laparoscopy and they were divided to 4 categories: no experience, minimal experience, basic and advanced laparoscopists. Tests consisted of 4 tasks: passage of a ligature, intracorporeal knotting, intracorporeal suturing, and cutting a carton circle out of a square. All tests were supervised and time was recorded for each of the tasks. Histograms were plotted showing the mean time for performance of each task in each experience group. The Kruskal-Wallis analysis of variance was used to assess statistical significance. RESULTS: Seven participants had no previous experience in laparoscopy and 14 had minimal experience. 15 had basic experience and 8 were advanced laparoscopists. No difference in performance was found between the no experience and minimal experience group and they were united and defined as beginners. A significant difference in performance was noted between the beginners, basic and advanced groups, especially when comparing beginners to advanced. Criterion level values of surgical performance drawn from this data were highly discriminative with sensitivity of 71-85% and specificity of 74.2%-88%. CONCLUSIONS: We were able to differentiate between various levels of laparoscopic skills among the participating urologists. Values drawn from such studies could be the basis of criterion level values for technical laparoscopic performance during training programs and before granting laparoscopic privileges to urologists.

Adult↗
PubMed2005

Urinary/serum prostate-specific antigen ratio: comparison with free/total serum prostate-specific antigen ratio in improving prostate cancer detection.

OBJECTIVES: To test the previously reported hypothesis, that the urinary/total serum (U/S) prostate-specific antigen (PSA) ratio improves the detection of prostate cancer, by evaluating the clinical usefulness of the U/S PSA ratio and comparing it with the free/total (F/T) serum PSA ratio. METHODS: A total of 165 patients undergoing transrectal ultrasound-guided prostate biopsy were prospectively included in this multicenter study. In all patients, PSA was measured from preoperative serum and 12-hour urine specimens in a centralized laboratory. RESULTS: Prostate cancer was identified in 83 of 165 patients. The differences between patients with and without prostate cancer were statistically significant (P <0.001) when considering the total PSA value (median, 10.2 ng/mL and 6.6 ng/mL respectively), F/T serum PSA ratio (0.11 and 0.18), and U/S PSA ratio (1.2 and 4.2). In the group of 79 patients with a PSA level between 4 and 10 ng/mL, receiver operating characteristic curves showed that the U/S PSA ratio was associated with a larger area under the curve (0.63; 95% confidence interval, 0.51 to 0.73) than the total PSA value (0.55; 95% confidence interval, 0.43 to 0.66) or F/T serum PSA ratio (0.60; 95% confidence interval, 0.49 to 0.71). The U/S PSA ratio did not correlate with patient age or prostate volume. CONCLUSIONS: Our results confirmed that the U/S PSA ratio may be a useful test in prostate cancer detection when the total serum PSA level is between 4 and 10 ng/mL. The F/T serum PSA ratio and U/S PSA ratio did not correlate. This suggests that these two tests could complement each other.

Aged↗
PubMed2005

Effects of long-term finasteride treatment on prostate cancer morphology and clinical outcome.

OBJECTIVES: To examine the morphologic alterations of finasteride therapy on prostate cancer compared with no treatment or treatment with a luteinizing hormone-releasing hormone (LHRH) agonist and the clinical outcomes of patients treated with finasteride. METHODS: The data of 56 patients with prostate cancer who had taken finasteride for at least 6 months were reviewed. A central pathology review was performed in a blinded manner comparing these patients with 56 matched controls and 44 patients who received a 3-month course of LHRH agonist before radical prostatectomy. The histologic hormonal treatment effects included apoptosis, vacuolated cytoplasm, pyknotic nuclei, and small irregular glands. An overall consensus was scored using a three-tiered system: no apparent effect (score = 0), suspicious for hormonal effect (score = 1), and highly suggestive of hormonal treatment (score = 2). A Gleason score was assigned to all prostatectomy specimens. RESULTS: The mean hormonal treatment score for the prostatectomy specimens was 0.4, 0.5, and 1.6 for the control, finasteride, and 3-month LHRH groups, respectively. Surprisingly, 20% of control patients had suspicious or highly suggestive hormonal effects and 26% of the finasteride-treated patients did so. For the LHRH-treated group, only 23% did not demonstrate classic features of hormonal treatment. Similar clinical outcomes were observed between the finasteride and control groups. CONCLUSIONS: No consistent hormonal therapy effects with finasteride treatment were observed compared with LHRH agonists. The hormonal effect was observed in the control group. Therefore, although other aspects of the Prostate Cancer Prevention Trial design might account for the greater percentage of Gleason grade tumors in the study arm, morphologic changes due to long-term finasteride treatment were not a likely cause.

Adult↗
PubMed2005

Update on laparoscopic and robotic radical prostatectomy.

PURPOSE OF REVIEW: Laparoscopic and robotic-assisted prostatectomy have been proposed as alternatives to traditional open retropubic prostatectomy. In this review, we update the more recent data concerning the results, technical trends and controversies regarding these novel, minimally invasive procedures. RECENT FINDINGS: As a result of improved patient selection, a better understanding of surgical anatomy, and refinements in surgical techniques, traditional retropubic prostatectomy set the standards very high, leaving little room for improvement. In this review, the results of laparoscopic prostatectomy are compared with contemporary in addition to historical series. Besides the transperitoneal laparoscopic approach, which was almost exclusively used in the initial series, the introduction and development of the extraperitoneal laparoscopic approach meant a significant change in the surgical strategy of a number of teams worldwide. The relative merits of the transperitoneal and extraperitoneal approaches are discussed. Robotic radical prostatectomy is a promising technical innovation that allows us to overcome many of the inherent limitations of laparoscopic surgery. As a result of financial constraints, the experience has been limited to a few centres worldwide. SUMMARY: Although long-term results are still lacking, novel minimally invasive techniques seem to fulfil the highest standards of radical prostatectomy in terms of early oncological cure, functional results and morbidity. A standardization of data collection and evaluation methodology will be indispensable for a better comparison of the different series.

Blood Loss, Surgical↗
PubMed2004

Justification of extraperitoneal laparoscopic access for surgery of the upper urinary tract.

Laparoscopic surgery was originally developed by gynecologists and general surgeons. Based on their experience, the first successful laparoscopic procedures in urology were performed transperitoneally. However, this novel technique transformed traditionally retroperitoneal procedures into transperitoneal procedures, giving free rein to distinct intraperitoneal complications. Retroperitoneal laparoscopy was a later development in urology. This approach has gained increasing popularity throughout the years and has challenged the transperitoneal laparoscopic route in many aspects. This review focuses on the advantages of retroperitoneal laparoscopic surgery of the upper urinary tract.

Clinical Competence↗
PubMed2004

Frequency, clinical presentation and evolution of renal oncocytomas: multicentric experience from a European database.

OBJECTIVES: To understand the clinical behavior of renal oncocytoma in a retrospective analysis of a European multicentric nephrectomies database. METHODS: The records of 891 patients who underwent surgical resection of renal neoplasm were reviewed. Relevant clinical and pathological data for each patient were retrieved in a database. RESULTS: Thirty-two (3.6%) cases of renal oncocytoma were identified. Twenty patients (62.5%) were asymptomatic. No case of lymphatic invasion or metastatic disease, nor any evidence of vascular or fat tissue invasion was found. Thirty-one cases (96%) exhibited low mitotic activity. In one case the presence of renal clear cell carcinoma (diameter: 1.5cm) was found. After a median follow-up of 42 months, 87.5% of patients were alive with no evidence of tumor, while 9.3% of patients had died for non-malignant causes. One patient had not treated the tumor surgically and was disease-free at a 27-month follow-up. CONCLUSIONS: Renal oncocytoma is a benign neoplasm, characterized by slow growth and excellent prognosis after surgery. Nephron sparing techniques may be adequate for tumor removal.

Adenocarcinoma, Clear Cell↗