Magyar onkologia最新文献

The aim of this study was to analyze the trends and clinical outcomes of minimally invasive surgical techniques in the treatment of endometrial carcinoma at the National Institute of Oncology, Department of Gynecology, from 2016 to 2023. This retrospective study included patients with endometrial carcinoma stages I-IV who underwent primary surgical treatment between 2016 and 2023. The techniques analyzed were total laparoscopic hysterectomy (TLH), robotic- assisted hysterectomy (RAH), and total abdominal hysterectomy (TAH). A total of 1127 patients were included. The number of minimally invasive surgeries increased significantly: in 2016, there were 69 laparotomies and 1 TLH, while in 2023, there were 57 laparotomies, 19 TLHs and 123 robotic-assisted hysterectomies. As a conclusion, the use of minimally invasive techniques significantly increased in the treatment of endometrial carcinoma. The entire team, including anesthesiologists, gained experience in managing morbidly obese patients, enabling safe minimally invasive surgeries.

Endometrial carcinoma is the most common type of gynaecological cancer. Its primary incidence is highest around the age of 60. The majority of cases are detected at an early stage and therefore have a good prognosis. The majority of patients suffer from obesity, which makes primary surgical treatment difficult. Minimally invasive surgery, as recommended by international protocols, is the first choice for appropriate surgical treatment and significantly reduces the incidence of complications for patients. Robotic techniques are particularly important in the care of patients with often abnormal obesity. In this article, we summarise our knowledge of endometrial carcinoma and our experience with da Vinci robot-assisted surgery, which started almost 2 years ago at Semmelweis University.

Prostate cancer is one of the most commonly seen malignancies. Radical prostatectomy - open, laparoscopic or robot-assisted - is considered the first-line treatment for intermediate and high-risk prostate cancer, along with radiotherapy, if the expected survival is greater than 10 years. Radical prostatectomy is also considered in case of low-risk patients alongside active follow-up. Today, robot-assisted radical prostatectomy is the most common surgical treatment for localised prostate cancer. It is associated with shorter hospitalisation times and lower transfusion requirements compared to open surgery. Satisfactory long-term biochemical recurrence-free survival and tumour-specific survival can be achieved with robot-assisted radical prostatectomy in the treatment of low-, intermediate- and highrisk prostate cancer. It has the advantage of rapid postoperative continence recovery and high potency recovery rates. The cost of the minimal invasive approach is higher compared to open radical prostatectomy, and the benefits of faster postoperative recovery should be further investigated to quantify cost-effectiveness. The robot-assisted approach has enabled a number of new surgical techniques and further rapid advances in this field are expected.

Recently, organ preservation has gained importance for head and neck malignancies. The negative consequences of the therapies can be reduced without compromising the survival and the quality of life. Accordingly, transoral robotic surgery (TORS) is gaining ground internationally. We have been performing TORS procedures at the University of Pécs since January 2023. We operated on 27 patients until July 2024, including fifteen p16-positive tumors. Neck dissections were performed in 19 cases. The use of TORS is helpful in oropharyngeal cases, where inaccessible structures can be reached minimally invasively, compared to other transoral approaches. This is important for young patients with human papillomavirus-associated tumors, which have a better prognosis and longer life expectancy. TORS also has advantages over the previously used approaches for cancer of unknown primary (CUP). Compared to the standardly used FDG-PET/CT and "blindly" taken biopsies, TORS offers a higher detection rate of the primary tumor, by performing tonsillectomy and complete mucosectomy of the tongue base.

The introduction of robot-assisted minimally invasive esophageal surgery (RAMIE) represents a significant advancement in minimally invasive surgery. The robot system typically includes a high-resolution 3D camera and specially maneuverable instruments that are controlled by the surgeon from a console. By reducing the trauma caused by the intervention, this method allows for faster recovery compared to traditional open surgeries. Furthermore, the increased range of motion provided by the robot instruments enables more precise manipulations in the area of the esophagus and surrounding tissues, thereby improving the effectiveness of tumor resections and reconstructions. The results of clinical trials are promising: there is a decrease in postoperative pain, a lower risk of complications, and a shorter hospital stay, while the oncological outcomes are at least equivalent to open surgeries. As technology advances, robot-assisted esophageal surgery is expected to spread more widely, providing better patient care and surgical outcomes for both benign and malignant esophageal diseases.

Our goal was to examine the postoperative indicators after the first 300 thoracic robotic cases in the National Institute of Oncology. We retrospectively analyzed the clinicopathological and postoperative indicators of the first 300 patients. We also compared the first 30 cases performed by one surgeon to his 30 VATS (video-assisted thoracic surgery) and open cases. The average hospital stay was 5.2 days, the chest tube was removed on the second day. Conversion, need for reoperation and morbidity was low (1.8%, 2% and 10.6%, respectively). The change in operating time slows down after 20 cases. The hospital stay and complications were slightly favorable with RATS (robotic-assisted thoracic surgery) than with VATS. The intensive care stay, however, was significantly shorter while the amount of removed lymph nodes was significantly higher in RATS procedures. As a conclusion, RATS is a safe technique in thoracic surgery. Moreover, more lymph nodes are removed with RATS which can lead to better staging.

The aim of our study was to summarize our initial experience with robot-assisted partial nephrectomy (RAPN) surgeries. Our data were obtained retrospectively by analyzing the data from the first RAPN surgeries performed at University of Pécs Clinical Centre. Between October 2022 and April 2024, we performed 53 robot-assisted partial nephrectomies. Due to our specific circumstances, including the lack of funding from the National Health Insurance Fund (OEP), we performed only 16 surgeries in the first eight months and 37 in the subsequent nine months. According to the PADUA score, 55% of the surgeries were categorized as simple, 36% as moderate, and 9% as highly complex. The average console time was 134 minutes, showing a decreasing trend with increased practice. The average warm ischemia time was 12 minutes. There were no conversions to open surgery, but one radical nephrectomy was performed due to peritoneal tumor infiltration. Our patients were discharged on the third postoperative day. The introduction of RAPN in our clinic, as the first provincial centre, was successful. The transition from laparoscopic partial nephrectomy quickly yielded good results despite performing only a few surgeries in the first eight months due to the lack of OEP funding. Nevertheless, our results clearly show that performing 20-30 robot-assisted surgeries per year per surgeon, as described in the literature, is minimally necessary.

Robot-assisted surgery has been available at the National Institute of Oncology since 2022. We report on the most important parameters of the colorectal robot-assisted surgery of the first 191 patients. Robotically assisted rectal surgery was compared with our previous laparoscopic and open surgical activities. Perioperative indicators of rectal cancer patients operated laparoscopically (n=225) and open (n=213) were retrospectively compared with patients operated robotically assisted (n=140). In comparison of the three groups (laparoscopic, open, robot-assisted), robotic surgery shows a significant advantage in quality of mesorectal excision (complete TME rate 77%, 72.7% and 90%, respectively), in the days of care (median 7, 9 and 5 days, respectively), hospital readmissions (8%, 16%, 6.4%), and the rate of sphincter preservation (68%, 60% and 89.5%). As a conclusion, robotic surgery is sufficiently safe from oncological point of view. It has a significant advantage in quality of lymph node dissection, shorter care, fewer hospital readmissions, partially lower morbidity rate and a higher sphincter preservation rate compared to laparoscopic and open surgeries.

Metaplastic breast tumour is a rare, aggressive, mostly triple- negative, dedifferentiated malignancy, which poorly responds to chemotherapy compared to other invasive breast tumours. Since 2000, the WHO has considered it as a separate entity among breast tumours. Given the extremely poor prognosis of the tumour, more studies are needed to establish the most effective treatment strategy supported by data to increase overall survival. The objective of our research was a retrospective analysis of 77 patients with metaplastic breast cancer treated between 01.01.2012 and 28.02.2023 at our institute. Following the descriptive statistics of the patients, the pathological or clinical response was examined in cases of 15 patients treated with neoadjuvant and 14 patients with palliative chemotherapy. Finally, we compared the overall and progression-free survival of metaplastic breast cancer patients treated at our institute with those described in the international literature. The research results, both at our institute and in the literature, are limited by the small number of cases. In our research, with similar numbers of cases as many other investigations, we obtained results close to international data, thereby supporting the collection of data and further research necessary for the most effective treatment strategy for this rare tumour.

Robotic surgery, as a type of minimally invasive surgery, is applied in the medical care, and offers numerous benefits for patients. In this article, the development and changes in robotics, and the aim of robot manufacturing will be reviewed. Furthermore, by summarizing the history of the surgical field, we are going to describe the main paradigm shifts, which show the human acceptance and usage of novel ideas in Europe and in the USA. As a summary, the complex structure, place in surgery and the advantages of the surgical robots and some state-of-the-art research projects will be described, to let us forecast the surgical field of the future.