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Abdelaziz A, Bhandari M, Elshabrawy A, Trecarten S, Dalla EE, Samara KA, Alsayegh F, Liss M, Mansour AM. Contemporary Trends of Holmium Laser Enucleation of the Prostate Utilization in the United States: A Comprehensive Analysis Using the National Surgical Quality Improvement Program Database (2011-2020). J Endourol 2024; 38:521-528. [PMID: 38299559 DOI: 10.1089/end.2023.0612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024] Open
Abstract
Introduction: The most recent American Urological Association (AUA) Guidelines advocated laser enucleation of the prostate (LEP) as a size-independent surgical option for benign prostatic hyperplasia (BPH). Despite its endorsement by AUA and the growing body of evidence supporting its safety and efficacy, the utilization of LEP remains limited in the United States. This study aimed to evaluate the utilization trends and perioperative outcomes of LEP compared with other surgical procedures used for BPH management. Methods: A retrospective cohort analysis was performed using American College of Surgeons National Surgical Quality Improvement Program data from 2011 to 2020. Patients undergoing prostatectomy for BPH were identified using specific current procedural terminology (CPT) codes. Baseline demographic data, preoperative risk factors, and postoperative outcomes were collected. Multivariable logistic regression was employed to assess predictors of holmium laser enucleation of the prostate (HoLEP) utilization and postoperative complications. Results: Out of 8,415,549 patients, 95,144 underwent prostatectomy for BPH. Procedures included HoLEP 5305 cases, transurethral resection of the prostate (TURP) 57,803 cases, repeated TURP (re-TURP) 5549 cases, photoselective vaporization of the prostate (PVP) 23,739 cases, and simple prostatectomy 2748 cases. HoLEP utilization showed a gradual increase, from 4.8% in 2015 to 7.6% in 2020. Multivariable regression revealed that HoLEP selection significantly increased from 2016 to 2020 (odds ratio [OR]: 1.251, p < 0.001), and there was less likelihood of HoLEP selection for African American patients (OR: 0.752, p < 0.001). HoLEP had significantly lower complication rates, including urinary tract infections, blood transfusions, 30-day readmission, and reoperation. Conclusion: Despite underutilization, the adoption of HoLEP has slightly increased since 2015, rising from 4.8% in 2015 to 7.6% in 2020. The underutilization could be attributed to a lack of availability and the steep learning curve.
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Affiliation(s)
- Ahmad Abdelaziz
- Department of Urology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Mukund Bhandari
- Department of Population Health Sciences, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Ahmed Elshabrawy
- Department of Urology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Shaun Trecarten
- Department of Urology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Emad Eddin Dalla
- Department of Urology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Kamel A Samara
- Department of Urology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Fadi Alsayegh
- Department of Urology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Michael Liss
- Department of Urology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Ahmed M Mansour
- Department of Urology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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Dursun F, Elshabrawy A, Wang H, Kaushik D, Liss MA, Svatek RS, Gore JL, Mansour AM. Impact of rural residence on the presentation, management and survival of patients with non-metastatic muscle-invasive bladder carcinoma. Investig Clin Urol 2023; 64:561-571. [PMID: 37932567 PMCID: PMC10630682 DOI: 10.4111/icu.20230125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/15/2023] [Accepted: 07/16/2023] [Indexed: 11/08/2023] Open
Abstract
PURPOSE To assess the impact of rural and remote residence on the receipt of guidelines-recommended treatment, quality of treatment and overall survival (OS) in patients with non-metastatic muscle-invasive bladder cancer (MIBC). MATERIALS AND METHODS Patients with MIBC were identified using National Cancer Database. Patients were classified into three residential areas. Logistic regression models were used to assess associations between geographic residence and receipt of radical cystectomy (RC) or chemoradiation therapy (CRT). Models were fitted to assess quality benchmarks of RC and CRT. RESULTS We identified 71,395 patients. Of those 58,874 (82.5%) were living in Metro areas, 8,534 (11.9%) in urban-rural adjacent (URA), and 3,987 (5.6%) in urban-rural remote to metro area (URR). URR residence was significantly associated with poor OS compared to URA and Metro residence (HR 0.87, 95% CI 0.81-0.94 and HR 0.90, 95% CI 0.87-0.93, p<0.001). There was no difference in the likelihood of receiving RC and CRT among different residential areas. Among patients who underwent RC; individuals living in URR were less likely to receive neoadjuvant chemotherapy and adequate lymph node dissection, and had a higher probability of positive surgical margin than those living in metro areas. For those who received CRT; individuals living in Metro areas were more likely to receive concomitant systemic therapy compared to URR. CONCLUSIONS Rural residence is associated with lower OS for MIBC patients and less likelihood of meeting quality benchmarks for RC and CRT. This data should be used to guide further health policy and allocation of resources for rural population.
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Affiliation(s)
- Furkan Dursun
- Department of Urology, University of Texas Health San Antonio, San Antonio, TX, USA.
| | - Ahmed Elshabrawy
- Department of Urology, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Hanzhang Wang
- Department of Urology, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Dharam Kaushik
- Department of Urology, University of Texas Health San Antonio, San Antonio, TX, USA
- UT Health San Antonio MD Anderson Cancer Center, San Antonio, TX, USA
| | - Michael A Liss
- Department of Urology, University of Texas Health San Antonio, San Antonio, TX, USA
- UT Health San Antonio MD Anderson Cancer Center, San Antonio, TX, USA
| | - Robert S Svatek
- Department of Urology, University of Texas Health San Antonio, San Antonio, TX, USA
- UT Health San Antonio MD Anderson Cancer Center, San Antonio, TX, USA
| | - John L Gore
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Ahmed M Mansour
- Department of Urology, University of Texas Health San Antonio, San Antonio, TX, USA
- UT Health San Antonio MD Anderson Cancer Center, San Antonio, TX, USA
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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El-Ghazaly TE, Abdelazim IA, Elshabrawy A. Intrauterine Levobupivacaine Instillation for Pain Control in Women Undergoing Diagnostic Hysteroscopy. Gynecol Minim Invasive Ther 2022; 11:209-214. [PMID: 36660333 PMCID: PMC9844048 DOI: 10.4103/gmit.gmit_48_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 10/05/2021] [Accepted: 11/09/2021] [Indexed: 01/22/2023] Open
Abstract
Objectives Many women experience pain and discomfort after hysteroscopic procedure. Pain and discomfort after hysteroscopic procedures can be explained by the cervical dilatation, intrauterine manipulation, and/or hydrodistension. This study designed to evaluate the efficacy of intrauterine levobupivacaine instillation for pain control in women undergoing diagnostic hysteroscopy. Materials and Methods One hundred and twenty (120) women scheduled for diagnostic hysteroscopy and endometrial biopsy due to uterine bleeding were included in this study and randomized either to levobupivacaine group or controls. At the end of hysteroscopy, 5 mL of 0.5% levobupivacaine was instilled intrauterine in levobupivacaine group, while 5 mL of 0.9% saline was instilled intrauterine in controls. Participants were kept in the hospital for 12 h after diagnostic hysteroscopy to detect the postoperative (PO) pain intensity using visual analog scale (VAS), and PO required analgesics. Results The VAS was significantly lower in levobupivacaine group compared to controls 3 h. PO (1.31 ± 1.02 vs. 1.62 ± 0.76, respectively), (P = 0.01), 6 h. PO (0.81 ± 1.24 vs. 1.53 ± 0.88, respectively), (P = 0.004), and 9 h. PO (0.55 ± 1.25 vs. 1.12 ± 0.95, respectively), (P = 0.01). The total PO required analgesics were significantly lower in levobupivacaine group compared to controls (P = 0.005). Conclusion The intrauterine levobupivacaine instillation was simple, and effective for pain relief after diagnostic hysteroscopy, it significantly decreased pain score assessed by VAS at 3, 6, and 9 h., PO, and it significantly decreased PO required analgesics.
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Affiliation(s)
| | - Ibrahim A. Abdelazim
- Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt,Department of Obstetrics and Gynecology, Ahmadi Hospital, Kuwait Oil Company, Ahmadi, Kuwait,Address for correspondence: Dr. Ibrahim A. Abdelazim, Department of Obstetrics and Gynecology, Ahmadi Hospital, Kuwait Oil Company, Kuwait, P.O. Box: 9758, 61008 Ahmadi, Kuwait. E-mail:
| | - A. Elshabrawy
- Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt
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Dursun F, Elshabrawy A, Wang H, Wu S, Liss MA, Kaushik D, Grosser D, Svatek RS, Mansour AM. Histological variants of non–muscle invasive bladder cancer: Survival outcomes of radical cystectomy vs. bladder preservation therapy. Urol Oncol 2022; 40:275.e1-275.e10. [DOI: 10.1016/j.urolonc.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 01/27/2022] [Accepted: 02/06/2022] [Indexed: 10/18/2022]
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Dursun F, Elshabrawy A, Wang H, Liss MA, Rodriguez R, Kaushik D, Mansour AM. MP57-16 IMPACT OF EXTENT OF LYMPHADENECTOMY ON ALL CAUSE MORTALITY IN PATIENTS WITH INTERMEDIATE AND HIGH-RISK PROSTATE CANCER MANAGED WITH RADICAL PROSTATECTOMY. J Urol 2022. [DOI: 10.1097/ju.0000000000002640.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Elshabrawy A, Wang H, Dursun F, Kaushik D, Liss M, Svatek RS, Mansour AM. Diffusion of robot-assisted radical cystectomy: Nationwide trends, predictors, and association with continent urinary diversion. Arab J Urol 2022; 20:159-167. [PMID: 35935907 PMCID: PMC9354633 DOI: 10.1080/2090598x.2022.2032562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Affiliation(s)
- Ahmed Elshabrawy
- Department of Urology, University of Texas (UT) Health, San Antonio, TX, USA
| | - Hanzhang Wang
- Department of Urology, University of Texas (UT) Health, San Antonio, TX, USA
| | - Furkan Dursun
- Department of Urology, University of Texas (UT) Health, San Antonio, TX, USA
| | - Dharam Kaushik
- Department of Urology, University of Texas (UT) Health, San Antonio, TX, USA
- UT Health San Antonio/MD Anderson Mays Cancer Center, San Antonio, TX, USA
| | - Michael Liss
- Department of Urology, University of Texas (UT) Health, San Antonio, TX, USA
- UT Health San Antonio/MD Anderson Mays Cancer Center, San Antonio, TX, USA
| | - Robert S. Svatek
- Department of Urology, University of Texas (UT) Health, San Antonio, TX, USA
- UT Health San Antonio/MD Anderson Mays Cancer Center, San Antonio, TX, USA
| | - Ahmed M. Mansour
- Department of Urology, University of Texas (UT) Health, San Antonio, TX, USA
- UT Health San Antonio/MD Anderson Mays Cancer Center, San Antonio, TX, USA
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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Garg H, Dursun F, Elshabrawy A, Wang H, Liss M, Kaushik D, Svatek R, Mansour A. Radical cystectomy vs systemic therapy in non-metastatic bladder cancer with advanced lymph nodal disease (cN2/N3 disease) using inverse probability weighting analysis. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00855-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Garg H, Dursun F, Elshabrawy A, Wang H, Rodriguez R, Pruthi D, Kaushik D, Mansour A, RODRIGUEZ RONALD. A comparative analysis of minimal invasive vs. open radical nephrectomy for stage III renal cell carcinoma. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01077-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Dursun F, Elshabrawy A, Wang H, Oelsen J, Liss M, Kaushik D, Ramamurthy C, Rodriguez R, Mansour AM. Impact of facility type and volume on survival in patients with metastatic renal cell carcinoma. Can J Urol 2021; 28:10806-10816. [PMID: 34657653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION To investigate the impact of facility type and volume on survival in patients with metastatic renal cell carcinoma (mRCC). MATERIALS AND METHODS We investigated the National Cancer Database for patients with mRCC. Patients were stratified according to treatment facility type (academic vs. non-academic) and facility volume (high, intermediate, and low). Kaplan-Meier survival estimates and Cox proportional hazard models were fitted to evaluate overall survival (OS) as a function of facility type, volume, and different treatment modalities. RESULTS A total of 27,598 patients were identified, of which 10,938 (40%) were treated at academic centers (AC) and 16,131 (60%) at non-academic centers (non-AC). Overall, 19,904 patients (72%) were treated in high-volume hospitals (HVH). Among patients treated at AC, 94% were treated at HVHs. Patients treated at AC were more likely to receive immunotherapy, undergo cytoreductive nephrectomy (CN) and metastasectomy. The 2 and 5 year OS rates for patients treated in AC were 29.7% (CI 28.8%-30.6%) and 13% (CI 12%-14%) vs. 21.7% (CI 21%-22.4%) and 8.4% (CI %7.91-%8.99) in the Non-AC, respectively (p < 0.001). Multivariate Cox regression analysis identified treatment at AC as an independent predictor of survival (HR 0.85, 95% CI 0.81-0.91, p < 0.001). Undergoing CN and receipt of immunotherapy was also associated with a survival benefit (HR 0.41, CI 0.40-0.43 and HR 0.63, CI 0.59-0.68 respectively, p < 0.001). CONCLUSIONS Treatment at ACs and HVHs was associated with a survival benefit in patients with mRCC. Patients treated at AC were more likely to receive immunotherapy, undergo CN and metastasectomy.
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Affiliation(s)
- Furkan Dursun
- Department of Urology, University of Texas Health Science Center at San Antonio, Texas, USA
| | - Ahmed Elshabrawy
- Department of Urology, University of Texas Health Science Center at San Antonio, Texas, USA
| | - Hanzhang Wang
- Department of Urology, University of Texas Health Science Center at San Antonio, Texas, USA
| | - James Oelsen
- Department of Urology, University of Texas Health Science Center at San Antonio, Texas, USA
| | - Michael Liss
- Department of Urology, University of Texas Health Science Center at San Antonio, Texas, USA
| | - Dharam Kaushik
- Department of Urology, University of Texas Health Science Center at San Antonio, Texas, USA
| | - Chethan Ramamurthy
- Department of Urology, University of Texas Health Science Center at San Antonio, Texas, USA
| | - Ronald Rodriguez
- Department of Urology, University of Texas Health Science Center at San Antonio, Texas, USA
| | - Ahmed M Mansour
- Department of Urology, University of Texas Health Science Center at San Antonio, Texas, USA
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Elshabrawy A, Wang H, Satsangi A, Wheeler K, Ramamurthy C, Pruthi D, Kaushik D, Liss M, Gelfond J, Fernandez R, Gore J, Svatek R, Mansour AM. Correlates of refusal of radical cystectomy in patients with muscle-invasive bladder cancer. Urol Oncol 2021; 39:236.e9-236.e20. [PMID: 33423936 DOI: 10.1016/j.urolonc.2020.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate factors associated with radical cystectomy (RC) refusal, subsequent treatment decisions, and their influence on overall survival (OS). MATERIALS AND METHODS We queried the National Cancer Database for patients with non-metastatic muscle-invasive bladder cancer (MIBC), cT2-T4M0. Patients who refused recommended RC were further stratified by treatment into chemotherapy, radiation therapy, chemoradiotherapy, and no treatment groups. Patients were excluded from the analysis if surgery was not planned, not recommended; or if survival data were unknown. Multivariate logistic regression modeling was utilized to identify independent predictors of refusing RC. Cox proportional hazards model with propensity score overlap weighting was utilized to identify survival predictors. Kaplan-Meier analysis was utilized to evaluate survival according to treatment. RESULTS A total of 74,159 MIBC patients were identified. Among patients with documented reasons for no surgery, 5.4% refused RC despite physician recommendation. Predictors of refusal on multivariate analysis included female gender (P = 0.016), advancing age ≥80 (vs. <60, P < 0.001), African American race (vs. white, P < 0.001) Medicaid (vs. private insurance, P < 0.001) and advancing T stage (T4 vs. T2, P < 0.001). Patients treated at academic centers were less likely to decline RC (vs. community centers, P < 0.001). Median survival after RC was 40.44 months vs. 12.52 months in refusal group. Undergoing chemoradiation had significantly improved survival in those patients compared to monotherapy or no treatment (hazard ratio 0.25, P < 0.001). Overlap weighted model Identified RC refusal as an independent predictor of poor OS (P < 0.001). CONCLUSIONS Several sociodemographic and clinical factors are associated with refusing radical cystectomy. Such refusal is associated with poor survival outcomes.
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Affiliation(s)
| | - Hanzhang Wang
- Department of Urology, UT Health San Antonio, San Antonio, TX
| | - Arpan Satsangi
- Department of Urology, UT Health San Antonio, San Antonio, TX
| | - Karen Wheeler
- Department of Urology, UT Health San Antonio, San Antonio, TX
| | | | - Deepak Pruthi
- Department of Urology, UT Health San Antonio, San Antonio, TX; UT Health San Antonio/MD Anderson Mays Cancer Center, San Antonio, TX
| | - Dharam Kaushik
- Department of Urology, UT Health San Antonio, San Antonio, TX; UT Health San Antonio/MD Anderson Mays Cancer Center, San Antonio, TX
| | - Michael Liss
- Department of Urology, UT Health San Antonio, San Antonio, TX; UT Health San Antonio/MD Anderson Mays Cancer Center, San Antonio, TX
| | - Jonathan Gelfond
- Department of Population Health Sciences, UT Health San Antonio, San Antonio, TX
| | - Roman Fernandez
- Department of Population Health Sciences, UT Health San Antonio, San Antonio, TX
| | - John Gore
- Department of Urology, University of Washington, Seattle, WA
| | - Robert Svatek
- Department of Urology, UT Health San Antonio, San Antonio, TX; UT Health San Antonio/MD Anderson Mays Cancer Center, San Antonio, TX
| | - Ahmed M Mansour
- Department of Urology, UT Health San Antonio, San Antonio, TX; UT Health San Antonio/MD Anderson Mays Cancer Center, San Antonio, TX; Urology and Nephrology Center, Mansoura University, Egypt.
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Gourley E, Hopson N, Elshabrawy A, M. Mansour A. Thulium laser enucleation of the prostate: A standardized 10-step approach for surgeons-in-training. Urology Video Journal 2020. [DOI: 10.1016/j.urolvj.2020.100072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Herrera JC, Ibilibor C, Wang H, Klein GT, Elshabrawy A, Chowdhury WH, Kaushik D, Liss M, Svatek R, Mansour AM. National Trends and Impact of Regionalization of Radical Cystectomy on Survival Outcomes in Patients with Muscle Invasive Bladder Cancer. Clin Genitourin Cancer 2020; 18:e762-e770. [PMID: 32641262 DOI: 10.1016/j.clgc.2020.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/14/2020] [Accepted: 05/16/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate national trends and the effect of surgical volume on perioperative mortality and overall survival (OS)in patients undergoing radical cystectomy (RC) for muscle invasive bladder cancer (MIBC). METHODS We investigated the National Cancer Database to identify patients with localized MIBC (cT2a-T4, M0) who underwent RC from 2004 to 2014. Demographics, 30- and 90-day mortality rates, as well as OS were analyzed. Hospitals were stratified into low-, medium-, and high-volume centers according to median number of RCs performed per year. Multivariate logistic regression models were fitted to identify independent predictors of perioperative mortality. Kaplan-Meier survival curves were generated to evaluate OS. Cox proportional hazard modeling was performed to identify independent predictors of OS. RESULTS A total of 24,763 patients with localized MIBC who underwent RC from 2004 to 2014 were included in the study. Overall, most (70.85%) RCs occurred at low-volume hospitals, whereas only 15.83% were performed at high-volume hospitals. Thirty-day mortality rates were 2.87%, 2.19%, and 1.83% (P < .01); and 90-day mortality rates were 8.25%, 6.9%, and 5.9% (P < .01) at low-, medium-, and high-volume hospitals, respectively. Multivariate analyses identified RC volume as an independent predictor of 30- and 90-day mortality. RC in high-volume hospitals was associated with a 35% risk reduction in 30-day mortality (odds ratio 0.65, 95% confidence interval [CI] 0.49-0.85; P < .01), and a 26% risk reduction in 90-day mortality (0.74, 95% CI, 0.63-0.87; P < .01). CONCLUSIONS Treatment at high-volume centers offers improved outcomes and OS benefit. However, in the United States, only 16% of RCs are performed in high-volume hospitals.
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Affiliation(s)
- Juan C Herrera
- Department of Urology, University of Texas Health, San Antonio, TX
| | - Christine Ibilibor
- Department of Urology, University of Texas Health, San Antonio, TX; Mays Cancer Center at UT Health San Antonio/MD Anderson, San Antonio, TX
| | - Hanzhang Wang
- Department of Urology, University of Texas Health, San Antonio, TX
| | | | - Ahmed Elshabrawy
- Department of Urology, University of Texas Health, San Antonio, TX
| | | | - Dharam Kaushik
- Department of Urology, University of Texas Health, San Antonio, TX; Mays Cancer Center at UT Health San Antonio/MD Anderson, San Antonio, TX
| | - Michael Liss
- Department of Urology, University of Texas Health, San Antonio, TX; Mays Cancer Center at UT Health San Antonio/MD Anderson, San Antonio, TX
| | - Robert Svatek
- Department of Urology, University of Texas Health, San Antonio, TX; Mays Cancer Center at UT Health San Antonio/MD Anderson, San Antonio, TX
| | - Ahmed M Mansour
- Department of Urology, University of Texas Health, San Antonio, TX; Mays Cancer Center at UT Health San Antonio/MD Anderson, San Antonio, TX; Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
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Klein G, Wang H, Elshabrawy A, Nashawi M, Gourley E, Liss M, Kaushik D, Wu S, Rodriguez R, Mansour AM. Analyzing National Incidences and Predictors of Open Conversion During Minimally Invasive Partial Nephrectomy for cT1 Renal Masses. J Endourol 2020; 35:30-38. [PMID: 32434388 DOI: 10.1089/end.2020.0161] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objectives: To analyze predictors of open conversion during minimally invasive partial nephrectomy (MIPN) for cT1 renal masses. Methods: The National Cancer Database (NCDB) was investigated for kidney cancer patients who underwent partial nephrectomy (PN) between 2010 and 2015. Patients who underwent MIPN were stratified into converted and nonconverted groups. Sociodemographics, facility characteristics, and surgical outcomes were compared between the two groups, and multivariate logistic regression model was fitted to identify independent predictors of open conversion. Results: In total, 54,246 patients underwent PN for kidney cancer during the 6-year period. Of those, 18,994 (35%) were open partial nephrectomies (OPNs) and 35,252 (64%) were MIPN. Overall, 1010 (2.87%) of MIPNs were converted to OPN. There was an increasing utilization of MIPN from 50.35% in 2010 to 74.73% in 2015. Patients who had open conversion had more 30-day readmissions (5.95% vs 3.31%, p < 0.01). On multivariate analysis; high-volume facility (>30 MIPNs/year), year of surgery (2015 vs 2010), and robotic approach predicted a lower likelihood of conversion (odds ratio [OR] 0.52, confidence interval [CI] 0.44-0.62; OR 0.59, CI 0.47-0.73; and OR 0.31, CI 0.27-0.35; respectively, p < 0.001 for all). Conversely, Medicaid (vs private insurance; OR 1.75, CI 1.39-2.19, p < 0.001) and male sex (OR 1.26, CI 1.11-1.44, p < 0.001) were independent predictors of conversion. Conclusions: Open conversion in MIPN occurred in 2.87% of cases. There was an increasing utilization of MIPN associated with decreased conversion rates. Higher volume hospitals and progressing year of surgery were associated with less likelihood of conversion.
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Affiliation(s)
- Geraldine Klein
- Department of Urology and UT Health San Antonio, San Antonio, Texas, USA
| | - Hanzhang Wang
- Department of Urology and UT Health San Antonio, San Antonio, Texas, USA
| | - Ahmed Elshabrawy
- Department of Urology and UT Health San Antonio, San Antonio, Texas, USA
| | - Mouhamed Nashawi
- Department of Urology and UT Health San Antonio, San Antonio, Texas, USA
| | - Eric Gourley
- Department of Urology and UT Health San Antonio, San Antonio, Texas, USA
| | - Michael Liss
- Department of Urology and UT Health San Antonio, San Antonio, Texas, USA
| | - Dharam Kaushik
- Department of Urology and UT Health San Antonio, San Antonio, Texas, USA
| | - Shenghui Wu
- Department of Population Health Sciences, UT Health San Antonio, San Antonio, Texas, USA
| | - Ronald Rodriguez
- Department of Urology and UT Health San Antonio, San Antonio, Texas, USA
| | - Ahmed M Mansour
- Department of Urology and UT Health San Antonio, San Antonio, Texas, USA.,Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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Gourley E, Elshabrawy A, De La Cerda J, Pruthi D, Neuman B, Mansour AM. Bilateral Retroperitoneal Laparoscopic Partial Nephrectomy for Bilateral Papillary Renal Cell Carcinoma. Urology Video Journal 2020. [DOI: 10.1016/j.urolvj.2020.100031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Cajipe M, Wang H, Elshabrawy A, Kaushik D, Liss M, Svatek R, Wu S, Chowdhury WH, Ramamurthy C, Mansour AM. Pathological downstaging following radical cystectomy for muscle-invasive bladder cancer: Survival outcomes in the setting of neoadjuvant chemotherapy versus transurethral resection only. Urol Oncol 2020; 38:231-239. [PMID: 31956078 DOI: 10.1016/j.urolonc.2019.12.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 11/11/2019] [Accepted: 12/23/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Neoadjuvant chemotherapy (NAC) improves survival for patients undergoing radical cystectomy for muscle-invasive bladder cancer (MIBC). The overall survival (OS) advantage with NAC is primarily seen in patients who achieve pathological downstaging. However, a substantial number of patients achieve pathological downstaging following transurethral resection (TUR) without NAC. OBJECTIVES To analyze the OS outcomes in patients who achieve pathological downstaging in the setting of NAC vs. TUR only. MATERIALS AND METHODS We reviewed the National Cancer Database (NCDB) for patients diagnosed with MIBC who underwent radical cystectomy between 2004 and 2014. Patients who achieved complete downstaging (CD) (pT0N0) or noninvasive downstaging (NID) (pT0/Tis/TaN0) were further analyzed. OS was evaluated by comparing those who underwent NAC to those who underwent TUR only. RESULTS A total of 24,763 patients with MIBC were identified. 1,781 (7.2%) patients had NID and 1,015 (4.1%) had CD. Of all patients, 3,838 (15.5%) underwent NAC. In patients with NID, 757 (42.5%) underwent NAC and 1024 (57.5%) had cystectomy after TUR only. In patients with CD, 465 (45.8%) had NAC, while 550 (54.2%) had TUR only. In both NID and CD, cT2 patients were more likely to have TUR only (P = 0.019, P < 0.001), cT3 patients were more likely to receive NAC (P = 0.008, P < 0.001). Compared to the TUR only group, NAC was associated with improved 5-year OS in those with NID, 77% compared to 68% (HR 0.68, 95% CI [0.52-0.90]), as well as those with CD, 80% vs. 70% (HR 0.59, 95% CI [0.39-0.89]). CONCLUSIONS NAC was associated with significant overall survival benefit in the subset of patients who achieved CD and NID at radical cystectomy. Overall, NAC was underutilized in patients with MIBC.
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Affiliation(s)
- Miguel Cajipe
- Department of Urology, UT Health San Antonio, San Antonio, TX
| | - Hanzhang Wang
- Department of Urology, UT Health San Antonio, San Antonio, TX
| | | | - Dharam Kaushik
- Department of Urology, UT Health San Antonio, San Antonio, TX; Mays Cancer Center at UT Health San Antonio/MD Anderson, San Antonio, TX
| | - Michael Liss
- Department of Urology, UT Health San Antonio, San Antonio, TX; Mays Cancer Center at UT Health San Antonio/MD Anderson, San Antonio, TX
| | - Robert Svatek
- Department of Urology, UT Health San Antonio, San Antonio, TX; Mays Cancer Center at UT Health San Antonio/MD Anderson, San Antonio, TX
| | - Shenghui Wu
- Department of Population Health Sciences, UT Health San Antonio, San Antonio, TX
| | | | - Chethan Ramamurthy
- Division of Medical Oncology, UT Health San Antonio, San Antonio, TX; Mays Cancer Center at UT Health San Antonio/MD Anderson, San Antonio, TX
| | - Ahmed M Mansour
- Department of Urology, UT Health San Antonio, San Antonio, TX; Mays Cancer Center at UT Health San Antonio/MD Anderson, San Antonio, TX; Department of Urology, Urology and Nephrology Center, Mansoura University, Egypt.
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