Search

Retroperitoneal pediatric laparoscopic nephrectomy is described in 3 patients requiring 3 to 5 hours with an estimated blood loss of 10 to 60 cc. The children returned to school within 7 days postoperatively. Advantages of this procedure include the avoidance of intraoperative repositioning of the patient and easy conversion to an open lumbodorsal approach, if necessary; early laparoscopic visualization of the renal artery; applicability in cases of previous abdominal surgery, and avoidance of intraperitoneal adhesion.

Cystoprostatectomy specimens were evaluated in 66 male patients operated on for a pathological condition of the bladder with no evidence of prostatic malignancy on preoperative clinical assessment. There were 38 prostate cancers identified in 25 of 66 patients (38 per cent). Multiple foci of adenocarcinoma were noted in 10 of 25 patients (40 per cent). The mean tumor volume was 0.11 cc, with half of the cancers being less than or equal to 0.01 cc in volume. All 38 cancers were completely localized to the prostate and exact anatomical sites of origin for each of the cancers within the prostate were mapped. Whereas anatomical distribution of the cancers in the anteroposterior dimension was roughly uniform, a distinct predominance of apical prostatic cancers was observed. Possible anatomical explanations and implications of these findings in terms of the apical surgical margins at radical prostatectomy and cystoprostatectomy, and the new technologies currently available for diagnosis of prostate cancer are discussed.

Morphological features in radical prostatectomy specimens from 11 stage A and 73 stage B prostatic carcinomas were compared by mapping of tumor locations, and determinations of cancer volumes and histological patterns. Small stage A cancers were located anteromedially, while small stage B carcinomas were concentrated against the posterior capsule at the rectal surface. Small stage A carcinomas commonly invaded the anterior fibromuscular stroma and benign prostatic hyperplasia nodules, features that were uncommon even in large stage B tumors. Stage A cancers often appeared to arise within benign prostatic hyperplasia nodules and had a distinctive histological appearance. Even when large, stage A carcinomas tended not to spread close to the rectal surface of the gland. Stages A and B cancers spanned a roughly comparable volume range, and both showed progressive dedifferentiation with increasing volume. It is proposed that stages A and B cancers are biologically similar malignancies, distinguished only by their site of origin. Prognosis for patients with stage A carcinoma probably is closely related to tumor volume and dedifferentiation, features that are not reliably estimated in tissue samples removed at operation for benign prostatic hyperplasia.