Vascular anatomical variants in renal surgery: classic and robotic approach

Vol. 52 No. 3 Suppl., 2011
This supplement was not sponsored by Outside Organizations.

ROMANIAN JOURNAL of MORPHOLOGY and EMBRYOLOGY

C. N. Manea, V. D. Stanca, D. Precup, I. Coman

Introduction and Objectives: Conservative renal surgery is based on the nephron-sparing principle. Renal arterial vascularization is of terminal type and the occlusion of an artery generates the necrosis of the corresponding region. The aim of this research is to analyze the anatomic particularities of the renal vascular system as they are highlighted in the course of standard and robotic surgeries. Patients and Methods: Between May 2006 and November 2010 we have performed 35 partial nephrectomies out of which 30 cases (85.7%) were performed by standard surgical approach and the other five (14%) were robot-assisted. In the same interval, we have done 103 pyeloplasties to obstruct the pyeloureteral junction: 65 (63%) were carried through by standard surgical approach, 32 (31%) by laparoscopic approach and six cases (6%) were robot-assisted. Results and Discussion: In 20 (54.3%) of cases, nine (25.7%) had two renal arteries (both superior and inferior), five (14.2%) had early ramifications of the renal artery outside the renal sinus, four (11.4%) patients showed two renal veins, one patient lacked the prepyelic venous plane, and in one patient we have found duplicate abdominal vena cava. Out of all the pyeloplasty cases, 31 (30%) showed an obstruction of the renal collecting system by crossing with a segmental artery or with a vein. Conclusions: Efficient renal surgery implies good knowledge of anatomical particularities of the renal vascular. The minimally invasive approach by robotic laparoscopy remains an essential coordinate in renal surgery and allows an efficient preparing of the vascular capital.

Corresponding author: Cristian Nicolae Manea, MD, PhD student, e-mail: cristian.nm@gmail.com

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ROMANIAN JOURNAL of MORPHOLOGY and EMBRYOLOGY

Felicia Recareanu, Cristiana Simionescu, Claudia Valentina Georgescu, Elena Pirici

We analyzed 75 cases of invasive ductal mammary carcinoma type NOS and focused on comparative investigation of hormonal receptors (estrogen receptor ER and progesterone receptor PR) and Her2/neu oncoprotein expression, according to which we ranked the cases in molecular classification subtypes, determining certain correlations between them and morphoclinical prognostic factors. 73.4% of cases were ER+ and 26.6% were ER-. PR was present in 62.6% of cases and absent in 37.4%. Phenotype ER+PR+ (58.6%) had the highest incidence, followed by ER-PR- (22.8%) and ER+PR- (14.6%). Phenotype ER-PR+ (4%) registered the lowest incidence. 14.8% of tumors were Her2/neu + score 3+, 4% had equivocal score 2+ and 81.3% were negative Her2/neu scored 0 and 1+. 9.5% of cases Her2/neu positive scored 3+ were ER+PR+ and 88.5% of cases Her2/neu negative scored 0-1 were ER+PR+. In terms of the correlation among the status of ER, PR and Her2/neu, we determined a molecular classification of the cases, obtaining the following incidences: luminal A 70% of cases, basal 14.7% of cases, luminal B 8.3%, the lowest incidence being registered at Her2, 7% of cases. Luminal A and basal subtypes were associated with patients aged over 50 years (82% for luminal A and 90% for basal), whereas luminal B and Her2 subtypes were registered mostly at patients aged under 60-year-old (83% for luminal B and 100% for Her2). Luminal A subtype was characterized by small tumors (92% of cases were T1-T2), well and moderately differentiated tumors (58% of cases were G1-G2). 83.3% of cases in luminal B subtype had tumors with dimensions ranked T2-T3, all cases being moderately and low differentiated. Her2 subtype had T2-T3 tumors in 60% of cases, which were G3 low differentiated in a percent of 80%. The basal subtype mostly had tumors larger than 5 cm (91% of cases were T2-T3), out of which only a case (9%) presented well-differentiated G1.

Corresponding author: Felicia Recareanu, PhD candidate, e-mail: feliciarecareanu@yahoo.com

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