Objective:There are many models to predict extracapsular extension(ECE)in patients with prostate cancer.We aimed to externally validate several models in a Japanese cohort.Methods:We included patients treated with rob...Objective:There are many models to predict extracapsular extension(ECE)in patients with prostate cancer.We aimed to externally validate several models in a Japanese cohort.Methods:We included patients treated with robotic-assisted radical prostatectomy for prostate cancer.The risk of ECE was calculated for each patient in several models(prostate side-specific and non-side-specific).Model performance was assessed by calculating the receiver operating curve and the area under the curve(AUC),calibration plots,and decision curve analyses.Results:We identified ECE in 117(32.9%)of the 356 prostate lobes included.Patients with ECE had a statistically significant higher prostate-specific antigen level,percentage of positive digital rectal examination,percentage of hypoechoic nodes,percentage of magnetic resonance imaging nodes or ECE suggestion,percentage of biopsy positive cores,International Society of Urological Pathology grade group,and percentage of core involvement.Among the sidespecific models,the Soeterik,Patel,Sayyid,Martini,and Steuber models presented AUC of 0.81,0.78,0.77,0.75,and 0.73,respectively.Among the non-side-specific models,the memorial Sloan Kettering Cancer Center web calculator,the Roach formula,the Partin tables of 2016,2013,and 2007 presented AUC of 0.74,0.72,0.64,0.61,and 0.60,respectively.However,the 95%confidence interval for most of these models overlapped.The side-specific models presented adequate calibration.In the decision curve analyses,most models showed net benefit,but it overlapped among them.Conclusion:Models predicting ECE were externally validated in Japanese men.The side-specific models predicted better than the non-side-specific models.The Soeterik and Patel models were the most accurate performing models.展开更多
Early-stage gastrointestinal cancer is often treated by endoscopic submucosal dissection(ESD)using a flexible endoscope.Compared with conventional percutaneous surgery,ESD is much less invasive and provides a high qua...Early-stage gastrointestinal cancer is often treated by endoscopic submucosal dissection(ESD)using a flexible endoscope.Compared with conventional percutaneous surgery,ESD is much less invasive and provides a high quality of life for the patient because it does not require a skin incision,and the organ is preserved.However,the operator must be highly skilled because ESD requires using a flexible endoscope with energy devices,which have limited degrees of freedom.To facilitate easier manipulation of these flexible devices,we developed a surgical robot comprising a flexible endoscope and two articulating instruments.The robotic system is based on a conventional flexible endoscope,and an extrapolated motor unit moves the endoscope in all its degrees of freedom.The instruments are thin enough to allow insertion of two instruments into the endoscope channel,and each instrument has a bending section that allows for up–down,right–left,and forward–backward motion.In this study,we performed an ex vivo feasibility evaluation using the proposed robotic system for ESD in a porcine stomach.The procedure was successfully performed by five novice operators without complications.Our findings demonstrated the feasibility of the proposed robotic system and,furthermore,suggest that even operators with limited experience can use this system to perform ESD.展开更多
文摘Objective:There are many models to predict extracapsular extension(ECE)in patients with prostate cancer.We aimed to externally validate several models in a Japanese cohort.Methods:We included patients treated with robotic-assisted radical prostatectomy for prostate cancer.The risk of ECE was calculated for each patient in several models(prostate side-specific and non-side-specific).Model performance was assessed by calculating the receiver operating curve and the area under the curve(AUC),calibration plots,and decision curve analyses.Results:We identified ECE in 117(32.9%)of the 356 prostate lobes included.Patients with ECE had a statistically significant higher prostate-specific antigen level,percentage of positive digital rectal examination,percentage of hypoechoic nodes,percentage of magnetic resonance imaging nodes or ECE suggestion,percentage of biopsy positive cores,International Society of Urological Pathology grade group,and percentage of core involvement.Among the sidespecific models,the Soeterik,Patel,Sayyid,Martini,and Steuber models presented AUC of 0.81,0.78,0.77,0.75,and 0.73,respectively.Among the non-side-specific models,the memorial Sloan Kettering Cancer Center web calculator,the Roach formula,the Partin tables of 2016,2013,and 2007 presented AUC of 0.74,0.72,0.64,0.61,and 0.60,respectively.However,the 95%confidence interval for most of these models overlapped.The side-specific models presented adequate calibration.In the decision curve analyses,most models showed net benefit,but it overlapped among them.Conclusion:Models predicting ECE were externally validated in Japanese men.The side-specific models predicted better than the non-side-specific models.The Soeterik and Patel models were the most accurate performing models.
基金A part of this work was supported by JSPS KAKENHI Grant Number 20H04552。
文摘Early-stage gastrointestinal cancer is often treated by endoscopic submucosal dissection(ESD)using a flexible endoscope.Compared with conventional percutaneous surgery,ESD is much less invasive and provides a high quality of life for the patient because it does not require a skin incision,and the organ is preserved.However,the operator must be highly skilled because ESD requires using a flexible endoscope with energy devices,which have limited degrees of freedom.To facilitate easier manipulation of these flexible devices,we developed a surgical robot comprising a flexible endoscope and two articulating instruments.The robotic system is based on a conventional flexible endoscope,and an extrapolated motor unit moves the endoscope in all its degrees of freedom.The instruments are thin enough to allow insertion of two instruments into the endoscope channel,and each instrument has a bending section that allows for up–down,right–left,and forward–backward motion.In this study,we performed an ex vivo feasibility evaluation using the proposed robotic system for ESD in a porcine stomach.The procedure was successfully performed by five novice operators without complications.Our findings demonstrated the feasibility of the proposed robotic system and,furthermore,suggest that even operators with limited experience can use this system to perform ESD.
