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Rich JM, Okhawere KE, Nguyen C, Ucpinar B, Zuluaga L, Razdan S, Saini I, Tuna Beksac A, Nguyen J, Calvo RS, Ahmed M, Mehrazin R, Abaza R, Stifelman MD, Kaouk J, Crivellaro S, Badani KK. Transperitoneal Versus Retroperitoneal Single-port Robotic-assisted Partial Nephrectomy: An Analysis from the Single Port Advanced Research Consortium. Eur Urol Focus 2023; 9:1059-1064. [PMID: 37394396 DOI: 10.1016/j.euf.2023.06.004] [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: 02/27/2023] [Revised: 05/20/2023] [Accepted: 06/09/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND In the surgical management of kidney tumors, such as in multiport technology, single-port (SP) robotic-assisted partial nephrectomy (RAPN) can be performed using the transperitoneal (TP) or retroperitoneal (RP) approach. However, there is a dearth of literature on the efficacy and safety of either approach for SP RAPN. OBJECTIVE To compare the peri- and postoperative outcomes of the TP and RP approaches for SP RAPN. DESIGN, SETTING, AND PARTICIPANTS This is a retrospective cohort study using data from the Single Port Advanced Research Consortium (SPARC) database of five institutions. All patients underwent SP RAPN for a renal mass between 2019 and 2022. INTERVENTION TP versus RP SP RAPN. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Baseline characteristics, and peri- and postoperative outcomes were compared between both the approaches using χ2 test, Fisher exact test, Mann-Whitney U test, and Student t test. RESULTS AND LIMITATIONS A total of 219 patients (121 [55.25%] TP, 98 [44.75%] RP) were included in the study. Of them, 115 (51.51%) were male, and the mean age was 60 ± 11 yr. RP had a significantly higher proportion of posterior tumors (54 [55.10%] RP vs 28 [23.14%] TP, p < 0.001), while other baseline characteristics were comparable between both the approaches. There was no statistically significant difference in ischemia time (18 ± 9 vs 18 ± 11 min, p = 0.898), operative time (147 ± 67 vs 146 ± 70 min, p = 0.925), estimated blood loss (p = 0.167), length of stay (1.06 ± 2.25 vs 1.33 ± 1.05 d, p = 0.270), overall complications (5 [5.10%] vs 7 [5.79%]), and major complication rate (2 [2.04%] vs 2 [1.65%], p = 1.000). No difference was observed in positive surgical margin rate (p = 0.472) or delta eGFR at median 6-mo follow-up (p = 0.273). Limitations include retrospective design and no long-term follow-up. CONCLUSIONS With proper patient selection based on patient and tumor characteristics, surgeons can opt for either the TP or the RP approach for SP RAPN, and maintain satisfactory outcomes. PATIENT SUMMARY The use of a single port (SP) is a novel technology for performing robotic surgery. Robotic-assisted partial nephrectomy (RAPN) is a surgery to remove a portion of the kidney due to kidney cancer. Depending on patient characteristics and surgeons' preference, SP can be performed via two approaches for RAPN: through the abdomen or through the space behind the abdominal cavity. We compared outcomes between these two approaches for patients receiving SP RAPN, finding that they were comparable. We conclude that with proper patient selection based on patient and tumor characteristics, surgeons can opt for either the TP or the RP approach for SP RAPN, and maintain satisfactory outcomes.
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Affiliation(s)
- Jordan M Rich
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Charles Nguyen
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Burak Ucpinar
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Laura Zuluaga
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shirin Razdan
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Indu Saini
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alp Tuna Beksac
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Ruben S Calvo
- Department of Urology, University of Illinois, Chicago, IL, USA
| | - Mutahar Ahmed
- Hackensack University Medical Center, Hackensack, NJ, USA
| | - Reza Mehrazin
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Jihad Kaouk
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Ketan K Badani
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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2
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Okhawere KE, Rich JM, Beksac AT, Zuluaga L, Saini I, Ucpinar B, Levieddin J, Joel IT, Deluxe A, Stifelman MD, Crivellaro S, Abaza R, Eun DD, Bhandari A, Hemal AK, Porter J, Mansour A, Pierorazio PM, Zaytoun O, Badani KK. Transperitoneal Versus Retroperitoneal Robotic-Assisted Partial Nephrectomy in Patients with Obesity. J Laparoendosc Adv Surg Tech A 2023; 33:835-840. [PMID: 37339434 DOI: 10.1089/lap.2023.0142] [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: 06/22/2023] Open
Abstract
Introduction: We aim to compare transperitoneal (TP) and retroperitoneal (RP) robotic partial nephrectomy (RPN) in obese patients. Obesity and RP fat can complicate RPN, especially in the RP approach where working space is limited. Materials and Methods: Using a multi-institutional database, we analyzed 468 obese patients undergoing RPN for a renal mass (86 [18.38%] RP, 382 [81.62%] TP). Obesity was defined as body mass index ≥30 kg/m2*. A 1:1 propensity score matching was performed adjusting for age, previous abdominal surgery, tumor size, R.E.N.A.L nephrometry score, tumor location, surgical date, and participating centers. Baseline characteristics and perioperative and postoperative data were compared. Results: In the propensity score-matched cohort, 79 (50%) TP patients were matched with 79 (50%) RP patients. The RP group had more posterior tumors (67 [84.81%], RP versus 23 [29.11%], TP; P < .001), while the other baseline characteristics were comparable. Warm ischemia time (interquartile range; 15 [10, 12], RP versus 14 [10, 17] minutes, TP; P = .216), operative time (129 [116, 165], RP versus 130 [95, 180] minutes, TP; P = .687), estimated blood loss (50 [50, 100], RP versus 75 [50, 150] mL, TP; P = .129), length of stay (1 [1, 1], RP versus 1 [1, 2] day, TP; P = .319), and major complication rate (1 [1.27%], RP versus 3 [3.80%], TP; P = .620) were similar. No significant difference was observed in positive surgical margin rate and delta estimated glomerular filtration at follow-up. Conclusion: TP and RP RPN yielded similar perioperative and postoperative outcomes in obese patients. Obesity should not be a factor in determining optimal approach for RPN.
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Affiliation(s)
- Kennedy E Okhawere
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jordan Miller Rich
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alp Tuna Beksac
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Laura Zuluaga
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Indu Saini
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Burak Ucpinar
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Joshua Levieddin
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Iretiayo T Joel
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Radiology, University College Hospital, Ibadan, Nigeria
| | - Anthony Deluxe
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael D Stifelman
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Simone Crivellaro
- Department of Urology, University of Illinois, Chicago, Illinois, USA
| | | | - Daniel D Eun
- Department of Urology, Lewis Katz School of Medicine Temple University, Philadelphia, Pennsylvania, USA
| | - Akshay Bhandari
- Division of Urology, Mount Sinai Medical Center, Miami Beach, Florida, USA
| | - Ashok K Hemal
- Department of Urology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - James Porter
- Department of Urology, Swedish Medical Center, Seattle, Washington, USA
| | - Ahmed Mansour
- Department of Urology, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Phillip M Pierorazio
- Division of Urology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Osama Zaytoun
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ketan K Badani
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Treacy PJ, Martini A, Falagario UG, Ratnani P, Wajswol E, Beksac AT, Wiklund P, Nair S, Kyprianou N, Durand M, Tewari AK. Association between Expression of Connective Tissue Genes and Prostate Cancer Growth and Progression. Int J Mol Sci 2023; 24:ijms24087520. [PMID: 37108678 PMCID: PMC10139147 DOI: 10.3390/ijms24087520] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/13/2023] [Accepted: 03/16/2023] [Indexed: 04/29/2023] Open
Abstract
To find an association between genomic features of connective tissue and pejorative clinical outcomes on radical prostatectomy specimens. We performed a retrospective analysis of patients who underwent radical prostatectomy and underwent a Decipher transcriptomic test for localized prostate cancer in our institution (n = 695). The expression results of selected connective tissue genes were analyzed after multiple t tests, revealing significant differences in the transcriptomic expression (over- or under-expression). We investigated the association between transcript results and clinical features such as extra-capsular extension (ECE), clinically significant cancer, lymph node (LN) invasion and early biochemical recurrence (eBCR), defined as earlier than 3 years after surgery). The Cancer Genome Atlas (TCGA) was used to evaluate the prognostic role of genes on progression-free survival (PFS) and overall survival (OS). Out of 528 patients, we found that 189 had ECE and 27 had LN invasion. The Decipher score was higher in patients with ECE, LN invasion, and eBCR. Our gene selection microarray analysis showed an overexpression in both ECE and LN invasion, and in clinically significant cancer for COL1A1, COL1A2, COL3A1, LUM, VCAN, FN1, AEBP1, ASPN, TIMP1, TIMP3, BGN, and underexpression in FMOD and FLNA. In the TCGA population, overexpression of these genes was correlated with worse PFS. Significant co-occurrence of these genes was observed. When presenting overexpression of our gene selection, the 5-year PFS rate was 53% vs. 68% (p = 0.0315). Transcriptomic overexpression of connective tissue genes correlated to worse clinical features, such as ECE, clinically significant cancer and BCR, identifying the potential prognostic value of the gene signature of the connective tissue in prostate cancer. TCGAp cohort analysis showed a worse PFS in case of overexpression of the connective tissue genes.
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Affiliation(s)
- Patrick-Julien Treacy
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Urology and Organ Transplantation, Nice University Hospital, 06003 Nice, France
| | - Alberto Martini
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Urology, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Ugo Giovanni Falagario
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Urology and Organ Transplantation, University of Foggia, 71122 Foggia, Italy
| | - Parita Ratnani
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Ethan Wajswol
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Alp Tuna Beksac
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Peter Wiklund
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Sujit Nair
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Natasha Kyprianou
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Matthieu Durand
- Department of Urology and Organ Transplantation, Nice University Hospital, 06003 Nice, France
| | - Ashutosh K Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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Okhawere KE, Grauer R, Zuluaga L, Meilika KN, Ucpinar B, Beksac AT, Razdan S, Saini I, Abramowitz C, Abaza R, Eun DD, Bhandari A, Hemal AK, Porter J, Stifelman MD, Menon M, Badani KK. Operative and oncological outcomes of salvage robotic radical and partial nephrectomy: a multicenter experience. J Robot Surg 2023:10.1007/s11701-023-01538-6. [PMID: 36928751 DOI: 10.1007/s11701-023-01538-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 01/08/2023] [Indexed: 03/18/2023]
Abstract
We aim to describe the perioperative and oncological outcomes for salvage robotic partial nephrectomy (sRPN) and salvage robotic radical nephrectomy (sRRN). Using a prospectively maintained multi-institutional database, we compared baseline clinical characteristics and perioperative and postoperative outcomes, including pathological stage, tumor histology, operative time, ischemia time, estimated blood loss (EBL), length of stay (LOS), postoperative complication rate, recurrence rate, and mortality. We identified a total of 58 patients who had undergone robotic salvage surgery for a recurrent renal mass, of which 22 (38%) had sRRN and 36 (62%) had sRPN. Ischemia time for sRPN was 14 min. The median EBL was 100 mL in both groups (p = 0.581). One intraoperative complication occurred during sRRN, while three occurred during sRPN cases (p = 1.000). The median LOS was 2 days for sRRN and 1 day for sRPN (p = 0.039). Postoperatively, one major complication occurred after sRRN and two after sRPN (p = 1.000). The recurrence reported after sRRN was 5% and 3% after sRPN. Among the patients who underwent sRRN, the two most prevalent stages were pT1a (27%) and pT3a (27%). Similarly, the two most prevalent stages in sRPN patients were pT1a (69%) and pT3a (6%). sRRN and sRPN have similar operative and perioperative outcomes. sRPN is a safe and feasible procedure when performed by experienced surgeons. Future studies on large cohorts are essential to better characterize the importance and benefit of salvage partial nephrectomies.
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Affiliation(s)
- Kennedy E Okhawere
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 6th Floor, New York City, NY, 10029, USA
| | - Ralph Grauer
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 6th Floor, New York City, NY, 10029, USA
| | - Laura Zuluaga
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 6th Floor, New York City, NY, 10029, USA
| | - Kirolos N Meilika
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 6th Floor, New York City, NY, 10029, USA
| | - Burak Ucpinar
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 6th Floor, New York City, NY, 10029, USA
| | - Alp Tuna Beksac
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 6th Floor, New York City, NY, 10029, USA
| | - Shirin Razdan
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 6th Floor, New York City, NY, 10029, USA
| | - Indu Saini
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 6th Floor, New York City, NY, 10029, USA
| | - Chiya Abramowitz
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 6th Floor, New York City, NY, 10029, USA
| | - Ronney Abaza
- Department of Urology, OhioHealth Dublin Methodist Hospital, Dublin, OH, USA
| | - Daniel D Eun
- Department of Urology, Lewis Katz School of Medicine Temple University, Philadelphia, PA, USA
| | - Akshay Bhandari
- Division of Urology, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Ashok K Hemal
- Department of Urology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - James Porter
- Department of Urology, Swedish Urology, Seattle, WA, USA
| | - Michael D Stifelman
- Department of Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Mani Menon
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 6th Floor, New York City, NY, 10029, USA
| | - Ketan K Badani
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 6th Floor, New York City, NY, 10029, USA.
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Cerrato C, Patel D, Autorino R, Simone G, Yang B, Uzzo R, Porpiglia F, Capitanio U, Porter J, Beksac AT, Minervini A, Antonelli A, Cerruto MA, Lau C, Ashrafi A, Eun D, Mottrie A, Mir C, Meagher MF, Puri D, Nguyen M, Dhanji S, Liu F, Pandolfo SD, Kutikov A, Montorsi F, Gill IS, Sundaram C, Kaouk J, Derweesh IH. Partial or radical nephrectomy for complex renal mass: a comparative analysis of oncological outcomes and complications from the ROSULA (Robotic Surgery for Large Renal Mass) Collaborative Group. World J Urol 2023; 41:747-755. [PMID: 36856832 DOI: 10.1007/s00345-023-04279-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [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: 08/05/2022] [Accepted: 01/01/2023] [Indexed: 03/02/2023] Open
Abstract
PURPOSE To compare outcomes of robotic-assisted partial nephrectomy (RAPN) and minimally invasive radical nephrectomy (MIS-RN) for complex renal masses (CRM). METHODS We conducted a retrospective multicenter analysis of CRM patients who underwent MIS-RN and RAPN. CRM was defined as RENAL score 10-12. Primary outcome was overall survival (OS). Secondary outcomes were cancer-specific survival (CSS), recurrence, and complications. Multivariable analysis (MVA) and Kaplan-Meier Analysis (KMA) were used to analyze functional and survival outcomes for RN vs. PN by pathological stage. RESULTS 926 patients were analyzed (MIS-RN = 437/RAPN = 489; median follow-up 24.0 months). MVA demonstrated lack of transfusion (HR = 1.63, p = 0.005), low-grade (HR = 1.18, p = 0.018) and smaller tumor size (HR = 1.05, p < 0.001) were associated with OS. Younger age (HR = 1.01, p = 0.017), high-grade (HR = 1.18, p = 0.017), smaller tumor size (HR = 1.05, p < 0.001), and lack of transfusion (HR = 1.39, p = 0.038) were associated with CSS. Increasing tumor size (HR = 1.18, p < 0.001), high-grade (HR = 3.21, p < 0.001), and increasing age (HR = 1.02, p = 0.009) were independent risk factors for recurrence. Type of surgery was not associated with major complications (p = 0.094). For KMA of MIS-RN vs. RAPN for pT1, pT2 and pT3, 5-year OS was 85% vs. 88% (p = 0.078); 82% vs. 80% (p = 0.442) and 84% vs. 83% (p = 0.863), respectively. 5-year CSS was 98% for both procedures (p = 0.473); 94% vs. 92% (p = 0.735) and 91% vs. 90% (p = 0.581). 5-year non-CSS was 87% vs. 93% (p = 0.107); 87% for pT2 (p = 0.485) and 92% for pT3 for both procedures (p = 0.403). CONCLUSION RAPN in CRM is not associated with increased risk of complications or worsened oncological outcomes when compared to MIS-RN and may be preferred when clinically indicated.
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Affiliation(s)
- Clara Cerrato
- Department of Urology, UC San Diego School of Medicine, 3855 Health Sciences Drive, Mail Code 0987, La Jolla, CA, 92093-0987, USA.,Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Devin Patel
- Department of Urology, UC San Diego School of Medicine, 3855 Health Sciences Drive, Mail Code 0987, La Jolla, CA, 92093-0987, USA
| | - Riccardo Autorino
- Division of Urology, VCU Health System, Richmond, USA.,Department of Urology, Rush University School of Medicine, Chicago, USA
| | - Giuseppe Simone
- Department of Urology, IRCCS-"Regina Elena" National Cancer Institute, Rome, Italy
| | - Bo Yang
- Department of Urology, Changhai Hospital, Shanghai, China
| | - Robert Uzzo
- Division of Urology and Urologic Oncology, Fox Chase Cancer Center, Philadelphia, USA
| | - Francesco Porpiglia
- Department of Urology, University of Turin-San Luigi Gonzaga Hospital, Turin, Italy
| | - Umberto Capitanio
- Unit of Urology, IRCCS San Raffaele Scientific Institute, Urological Research Institute (URI) Division of Experimental Oncology, Vita-Salute San Raffaele, University, Milan, Italy
| | | | - Alp Tuna Beksac
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, USA
| | | | - Alessandro Antonelli
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Maria Angela Cerruto
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Clayton Lau
- Division of Urology and Urologic Oncology, City of Hope Medical Center, Duarte, USA
| | - Akbar Ashrafi
- Institute of Urology, University of Southern California Keck School of Medicine, Los Angeles, USA
| | - Daniel Eun
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, USA
| | | | - Carmen Mir
- Department of Urology, IMED Hospitals, Valencia, Spain
| | - Margaret F Meagher
- Department of Urology, UC San Diego School of Medicine, 3855 Health Sciences Drive, Mail Code 0987, La Jolla, CA, 92093-0987, USA
| | - Dhruv Puri
- Department of Urology, UC San Diego School of Medicine, 3855 Health Sciences Drive, Mail Code 0987, La Jolla, CA, 92093-0987, USA
| | - Mimi Nguyen
- Department of Urology, UC San Diego School of Medicine, 3855 Health Sciences Drive, Mail Code 0987, La Jolla, CA, 92093-0987, USA
| | - Sohail Dhanji
- Department of Urology, UC San Diego School of Medicine, 3855 Health Sciences Drive, Mail Code 0987, La Jolla, CA, 92093-0987, USA
| | - Franklin Liu
- Department of Urology, UC San Diego School of Medicine, 3855 Health Sciences Drive, Mail Code 0987, La Jolla, CA, 92093-0987, USA
| | | | - Alexander Kutikov
- Division of Urology and Urologic Oncology, Fox Chase Cancer Center, Philadelphia, USA
| | - Francesco Montorsi
- Unit of Urology, IRCCS San Raffaele Scientific Institute, Urological Research Institute (URI) Division of Experimental Oncology, Vita-Salute San Raffaele, University, Milan, Italy
| | - Inderbir S Gill
- Institute of Urology, University of Southern California Keck School of Medicine, Los Angeles, USA
| | - Chandru Sundaram
- Department of Urology, Indiana University Health, Indianapolis, USA
| | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, USA
| | - Ithaar H Derweesh
- Department of Urology, UC San Diego School of Medicine, 3855 Health Sciences Drive, Mail Code 0987, La Jolla, CA, 92093-0987, USA.
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6
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Okhawere KE, Beksac AT, Patel RD, Razdan S, Badani KK. Standardization of Surgical Outcome Across the Tumor Complexity Spectrum in Robotic Partial Nephrectomy. J Laparoendosc Adv Surg Tech A 2023; 33:124-128. [PMID: 35980371 DOI: 10.1089/lap.2022.0275] [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] [Indexed: 11/13/2022] Open
Abstract
Introduction: Standardization of surgical steps or techniques can decrease error rates, increase efficiency, and ensure reproducible outcomes. In this study, we aimed to analyze the benefit of a standardized approach to robotic partial nephrectomy (RPN) on the reproducibility of outcomes across different tumor complexities. Methods: A single-center study of patients who have undergone a transperitoneal robotic-assisted partial nephrectomy for kidney cancer using the first assistant sparing technique between May 2014 and March 2022 was performed. Overall, 496 patients were included in the analysis. We compared clinical data and perioperative and postoperative outcomes for low, moderate, and high complexity score renal tumors. Tumor complexity was stratified using the Radius, Exophytic/Endophytic, Nearness to the collecting system or sinus, Anterior/Posterior, Location relative to the polar line nephrometry score. Data were compared using Kruskal-Wallis test, Chi-square test of Independence, and Fisher's exact test. Results: Of the patients in the study, 54.64% were low tumor complexities (n = 271), 40.32% were moderate tumor complexities (n = 200), and 5.04% were high tumor complexities (n = 25). High tumor complexity patients had significantly longer operative time (149 minutes versus 137 minutes moderate complexity versus 125 minutes low complexity, P = .001), longer ischemia time (12 minutes versus 11 minutes intermediate versus 10 minutes low complexity, P = .0001), and significant reduction in estimated glomerular filtration rate (-12.58 mL/min/1.73 m2 versus -5.51 mL/min/1.73 m2 intermediate versus -3.08 mL/min/1.73 m2 low complexity, P = .005). There was no significant difference in estimated blood loss (P = .074), blood transfusion rate (P = .454), postoperative complication rate (P = .527), surgical complication rate (P = .210), major complication rate (P = .098), length of hospital stay (P = .583), positive surgical margins (P = .872), and trifecta achievement (P = .740). Conclusion: Irrespective of tumor complexity, approaching RPN using a standardized approach will offer patients favorable perioperative outcomes. This approach has standardized our preoperative counseling, patient expectation, and postoperative surgical pathway across the tumor complexity spectrum.
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Affiliation(s)
- Kennedy E Okhawere
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alp Tuna Beksac
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rutul D Patel
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Shirin Razdan
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ketan K Badani
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Zhang JH, Zeinab MA, Ferguson EL, Beksac AT, Schwen ZR, Aminsharifi A, Eltemamy M, Kaouk J. Minimally-Invasive Radical Nephrectomy and Left-Sided Level II Caval Thrombectomy: A New Combined Technique. Urology 2023; 172:220-223. [PMID: 36436673 DOI: 10.1016/j.urology.2022.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/22/2022] [Accepted: 10/02/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To present a combined multiport robotic and open approach for left radical nephrectomy and inferior vena cava thrombectomy in patients with a primary left renal mass and level II inferior vena cava (IVC) tumor thrombus. METHODS A 69-year-old female was diagnosed with an 8.9cm left renal neoplasm with level II IVC thrombus. She was placed in the left-side-up flank position. The descending colon was mobilized and the left gonadal vein was identified. The left renal vein was identified and fully dissected. The left renal artery was dissected and stapled. The kidney was dissected and left detached with exception of the renal vein. The robot was undocked and the patient was positioned supine. Through a supra-umbilical midline incision, the ascending colon and duodenum were mobilized medially. The right renal vein and IVC were identified and dissected to the level of hepatic veins. The IVC was clamped using a Satinsky clamp. The right renal artery and vein remained patent during thrombectomy. The IVC was opened, the thrombus was evacuated, and IVC was closed. Clamps were removed and the kidney was removed. RESULTS Operative time was 405 minutes. IVC clamp time was 14 minutes. Estimated blood loss was 500cc. Recovery was uncomplicated. Length of stay was 4 days. Pathology showed clear cell carcinoma with negative margins. CONCLUSION IVC thrombectomy is challenging on left sided tumors. Combining a robotic and open technique together is feasible and allows a smaller supra-umbilical midline incision compared to standard open incision.
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Affiliation(s)
- Jj H Zhang
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH
| | | | - Ethan L Ferguson
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Alp Tuna Beksac
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Zeyad R Schwen
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH
| | | | - Mohamed Eltemamy
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Jihad Kaouk
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH.
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Abou Zeinab M, Beksac AT, Ferguson E, Kaviani A, Moschovas MC, Joseph J, Kim M, Crivellaro S, Nix J, Patel V, Kaouk J. Single-port Extraperitoneal and Transperitoneal Radical Prostatectomy: A Multi-Institutional Propensity-Score Matched Study. Urology 2023; 171:140-145. [PMID: 36244472 DOI: 10.1016/j.urology.2022.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/21/2022] [Accepted: 10/02/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To compare the perioperative and early postoperative outcomes between single-port (SP) extraperitoneal radical prostatectomy (EPRP) and SP transperitoneal radical prostatectomy (TPRP), in a multi-institutional setting. METHODS We identified all patients who underwent SP robot-assisted radical prostatectomy at 6 different institutes. Data of 650 patients were collected and divided into 2 groups based on the surgical approach: SP EPRP or SP TPRP. A Propensity-score matched-pair analysis for body mass index (BMI), prostate size, and National Comprehensive Cancer Network risk was performed with a 1:1 ratio. Analysis of perioperative and postoperative outcomes was performed using Wilcoxon signed-rank test and chi-square and Fisher's exact tests. RESULTS After matching, 238 patients were included in each arm. The median follow-up period was 7 and 6 months for EPRP and TPRP groups, respectively. The total operative time was longer in the EPRP group (206 vs 155 minutes, P < .001). The EPRP group had a shorter length of hospitalization and same-day discharge rate compared to the TPRP approach (P < .001). There was no difference in the overall intraoperative or postoperative complications rate between the 2 groups, nor positive surgical margin rates. CONCLUSION The SP extraperitoneal approach is associated with a shorter hospital stay and higher rate of same-day discharge, with no difference in the surgical margin, or complication rates.
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Affiliation(s)
| | - Alp Tuna Beksac
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Ethan Ferguson
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Aaron Kaviani
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH
| | | | | | | | - Simone Crivellaro
- University of Illinois Hospital & Health Sciences System, Chicago, IL
| | - Jeffrey Nix
- University of Alabama Birmingham, Birmingham, AL
| | | | - Jihad Kaouk
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH.
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Okhawere KE, Beksac AT, Wilson MP, Korn TG, Meilika KN, Harrison R, Morgantini L, Ahmed M, Mehrazin R, Abaza R, Eun DD, Bhandari A, Hemal AK, Porter J, Stifelman MD, Kaouk J, Crivellaro S, Badani KK. A Propensity-Matched Comparison of the Perioperative Outcomes Between Single-Port and Multi-Port Robotic Assisted Partial Nephrectomy: A Report from the Single Port Advanced Research Consortium (SPARC). J Endourol 2022; 36:1526-1531. [PMID: 36053713 DOI: 10.1089/end.2022.0115] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 02/06/2023] Open
Abstract
Purpose: Single-port (SP) robotic surgery is a new technology and early in its adoption curve. The goal of this study is to compare the perioperative outcomes of SP to multi-port (MP) robotic technology for partial nephrectomy. Materials and Methods: This is a prospective cohort study of patients who have undergone robot-assisted partial nephrectomy using SP and MP technology. Baseline demographic, clinical, and tumor-specific characteristics and perioperative outcomes were compared using χ2, t-test, and Mann-Whitney U test in the overall cohort and in a 1:1 propensity score-matched cohort, adjusting for baseline characteristics. Results: After propensity matching, 146 SP patients were matched with 146 MP patients. SP and MP groups had similar mean age (58 ± 12 years vs 59 ± 12 years; p = 0.606) and proportion of men (54.11% vs 52.05%; p = 0.725). The SP had a longer mean ischemia (18.29 ± 10.49 minutes vs 13.79 ± 6.29 minutes; p < 0.001). Estimated blood loss (EBL) and length of hospital stay (LOS), operative time, positive margin rate, and any complication rate were similar between the two groups. Conclusions: SP partial nephrectomy had a longer ischemia time, and a comparable LOS, EBL, operative time, positive margin rates, and complication rates to MP. These early data are encouraging. However, the role of SP requires further study and should evaluate safety and long-term data when compared with the standard MP technique.
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Affiliation(s)
- Kennedy E Okhawere
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alp Tuna Beksac
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Michael P Wilson
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Talia G Korn
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kirolos N Meilika
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Robert Harrison
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Luca Morgantini
- Department of Urology, University of Illinois, Chicago, Illinois, USA
| | - Mutahar Ahmed
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Reza Mehrazin
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Daniel D Eun
- Department of Urology, Lewis Katz School of Medicine Temple University, Philadelphia, Pennsylvania, USA
| | - Akshay Bhandari
- Division of Urology, Mount Sinai Medical Center, Miami, Florida, USA
| | - Ashok K Hemal
- Department of Urology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - James Porter
- Department of Urology, Swedish Medical Center, Seattle, Washington, USA
| | - Michael D Stifelman
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Simone Crivellaro
- Department of Urology, University of Illinois, Chicago, Illinois, USA
| | - Ketan K Badani
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Kaouk JH, Ferguson EL, Beksac AT, Zeinab MA, Kaviani A, Weight C, Haywood S, Eltemamy M, Purysko A, McKenney JK, Klein E. Single-port Robotic Transvesical Partial Prostatectomy for Localized Prostate Cancer: Initial Series and Description of Technique. Eur Urol 2022; 82:551-558. [PMID: 35970657 DOI: 10.1016/j.eururo.2022.07.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 05/04/2022] [Revised: 06/30/2022] [Accepted: 07/19/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Partial prostatectomy has been described as an alternative to focal therapy for the management of localized low- and intermediate-risk prostate cancer. OBJECTIVE To describe early outcomes and technique for single-port (SP) transvesical partial prostatectomy. DESIGN, SETTING, AND PARTICIPANTS A retrospective analysis was performed for nine patients with low-volume, localized, low- to intermediate-risk prostate cancer (Gleason ≤7) undergoing SP transvesical partial prostatectomy replicating the inclusion criteria for focal therapy by a single surgeon from November 2020 to March 2022. SURGICAL PROCEDURE The daVinci SP access port was inserted percutaneously into the bladder and pnuemovesicum was achieved. The camera, robotic instruments, assistant port, and flexible suction tubing were introduced through the access port. The Koelis transrectal ultrasound with preoperative prostate magnetic resonance imaging fusion was used for intraoperative guidance. MEASUREMENTS Demographic information, intraoperative variables, and postoperative outcomes were collected in an institutional review board-approved database, and a descriptive statistical analysis was performed. RESULTS AND LIMITATIONS All cases were completed without requiring extra ports or conversion. No intraoperative complications were noted, and all patients were discharged on the day of surgery. Pathology showed Gleason scores of 3 + 3 = 6 in one case, 3 + 4 = 7 in seven cases, and 4 + 3 = 7 in one case, all with negative intraoperative margin assessment. At 6 wk, the median prostate-specific antigen was 0.5 and the median Sexual Health Inventory for Men score was 17.5 from 23 preoperatively. All patients were continent at 6 wk. The limitations include a small number of patients, short follow-up, and single-surgeon experience. CONCLUSIONS We demonstrated the feasibility of the SP robotic transvesical partial prostatectomy. Early functional outcomes show impressive time to continence and erectile function. Continued follow-up will evaluate long-term oncologic outcomes. PATIENT SUMMARY We performed partial prostatectomies in selected patients as an alternative to focal therapy using a novel transvesical single-port approach. Our approach was safe and feasible, with fewer complications and promising initial return to continence and erectile function.
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Affiliation(s)
- Jihad H Kaouk
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Ethan L Ferguson
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alp Tuna Beksac
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mahmoud Abou Zeinab
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Aaron Kaviani
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Christopher Weight
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Samuel Haywood
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mohamed Eltemamy
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Andrei Purysko
- Department of Radiology, Cleveland Clinic, Cleveland, OH, USA
| | | | - Eric Klein
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
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Beksac AT, Abou Zeinab M, Ferguson E, Kaviani A, Kaouk J. Single-port retroperitoneal robotic pyeloplasty: Description of technique. Urology Video Journal 2022. [DOI: 10.1016/j.urolvj.2022.100178] [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] Open
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12
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Kaviani A, Zeinab MA, Ferguson E, Beksac AT, Kaouk J. Robotic partial nephrectomy for hilar tumors: The contemporary technique. Urology Video Journal 2022. [DOI: 10.1016/j.urolvj.2022.100179] [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: 12/01/2022] Open
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13
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Beksac AT, Kaouk J. EDITORIAL COMMENT. Urology 2022; 165:204-205. [PMID: 35843693 DOI: 10.1016/j.urology.2022.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/13/2022] [Indexed: 10/17/2022]
Affiliation(s)
- Alp Tuna Beksac
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Jihad Kaouk
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH
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Beksac AT, Carbonara U, Abou Zeinab M, Meagher MF, Hemal S, Tafuri A, Tuderti G, Antonelli A, Autorino R, Simone G, Derweesh IH, Kaouk J. Redo Robotic Partial Nephrectomy for Recurrent Renal Tumors: A Multi-Institutional Analysis. J Endourol 2022; 36:1296-1301. [PMID: 35730123 DOI: 10.1089/end.2021.0954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
INTRODUCTION As the experience with robot assisted partial nephrectomy (RAPN) grows, the indications have expanded to incorporate previously operated ipsilateral kidneys with recurrent renal masses. We sought to analyze the outcomes of redo RAPN in patients with a recurrent renal mass. METHODS Using a multi-institutional series, the data of 72 patients who underwent RAPN for a recurrent renal mass between 2010 and 2020 were retrospectively analyzed. Patients with familial renal cell carcinoma and multiple renal tumors were excluded. Major complication defined by Clavien grade ≥3. The median follow-up was 28.5 months. Baseline demographics, clinical and tumor characteristics, perioperative and postoperative outcomes are reported. RESULTS Our cohort consisted of a combination of previous thermal ablation (19.6%), laparoscopic (19.6%), open (26.1%), and robotic (34.8%) partial nephrectomy. The median RENAL score was 8. Twenty percent had hilar tumors and 9.7% had a solitary kidney. RAPN was completed in all cases. Two cases (2.8%) were converted to open surgery. None of the cases were converted to radical nephrectomy intraoperatively. One patient underwent radical nephrectomy postoperatively due to bleeding. Transfusion rate was 5.9% and major complication rate was 8.3%. Median length of stay was 3 days. eGFR preservation was 78.7% at discharge and 90.8% at one-year follow-up. Positive surgical margin rate was 8.3%. Overall, distant recurrence was seen in 11 patients (15.3%), however, only one patient had local progression (1.4%). CONCLUSION In experienced hands, RAPN is an effective approach to treat select cases of locally recurrent renal masses with promising perioperative and functional outcomes. Patients should be carefully monitored for distant recurrence.
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Affiliation(s)
- Alp Tuna Beksac
- Cleveland Clinic Glickman Urological and Kidney Institute, 273142, Urology, 9500 Euclid Avenue Q10, Cleveland, Ohio, United States, 44195-0001;
| | - Umberto Carbonara
- Virginia Commonwealth University Health System, 6887, Department of Urology, 11200 E BROAD ST, RICHMOND, Richmond, Virginia, United States, 23233.,Università degli Studi di Bari Aldo Moro, 9295, Department of Urology, Bari, Puglia, Italy;
| | - Mahmoud Abou Zeinab
- Cleveland Clinic Glickman Urological and Kidney Institute, 273142, Urology, 9500 Euclid Ave, Cleveland, OH 44195, Cleveland, Ohio, United States, 44195;
| | - Margaret F Meagher
- University of California San Diego School of Medicine, 12220, Urology, La Jolla, California, United States;
| | - Sij Hemal
- Cleveland Clinic Glickman Urological and Kidney Institute, 273142, Urology, Cleveland, Ohio, United States;
| | - Alessandro Tafuri
- University of Verona School of Medicine and Surgery, 60271, Dept of Urology University of Verona, Verona, Veneto, Italy.,University of Verona School of Medicine and Surgery, 60271, Urology, Verona, Veneto, Italy.,University of Verona School of Medicine and Surgery, 60271, Dept of Urology University of Verona, Verona, Veneto, Italy.,University of Verona School of Medicine and Surgery, 60271, Urology, Verona, Veneto, Italy;
| | | | - Alessandro Antonelli
- University of Verona School of Medicine and Surgery, 60271, Urology, Verona, Veneto, Italy;
| | - Riccardo Autorino
- Virginia Commonwealth University School of Medicine, 6886, Urology, Richmond, Virginia, United States;
| | - Giuseppe Simone
- Regina Elena, urology, Roma, Italy.,Regina Elena Institute, 18658, Urology, Roma, Lazio, Italy;
| | - Ithaar H Derweesh
- University of California San Diego School of Medicine, Department of Surgery/Division of Urology, Moores UCSD Cancer Center, 3855 Health Sciences Drive, Mail Code 0987, La Jolla, California, United States, 92093;
| | - Jihad Kaouk
- Cleveland Clinic Foundation, Glickman Urologic Institute, 9500 Euclid Ave, Cleveland, Ohio, United States, 44195;
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Abou Zeinab M, Kaviani A, Beksac AT, Ferguson E, Kaouk J. Single port transvesical simple prostatectomy: A minimally invasive technique in BPH management. Urology Video Journal 2022. [DOI: 10.1016/j.urolvj.2022.100158] [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: 10/18/2022] Open
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16
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Kaviani A, Eltemamy M, Lin YC, Zeinab MA, Beksac AT, Ferguson E, Wee A, Kaouk J. MP36-02 SINGLE PORT ROBOTIC VERSUS OPEN KIDNEY TRANSPLANTATION: A COMPARISON OF OUTCOMES. J Urol 2022. [DOI: 10.1097/ju.0000000000002590.02] [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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Kaviani A, Kaouk J, Zeinab MA, Beksac AT, Ferguson E, Lin YC, Wee A, Eltemamy M. V05-02 SINGLE PORT ROBOT-ASSISTED EXTRAPERITONEAL KIDNEY TRANSPLANTATION: TIPS AND TRICKS. J Urol 2022. [DOI: 10.1097/ju.0000000000002579.02] [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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Beksac AT, Zeinab MA, Ferguson E, Kaviani A, Kaouk J. Single-Port Extraperitoneal Robot Assisted Radical Prostatectomy – Description of Technique. Urology Video Journal 2022. [DOI: 10.1016/j.urolvj.2022.100162] [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: 10/18/2022] Open
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Beksac AT, Ratnani P, Dovey Z, Parekh S, Falagario U, Roshandel R, Sobotka S, Kewlani D, Davis A, Weil R, Bashorun H, Jambor I, Lewis S, Haines K, Tewari AK. Unified model involving genomics, magnetic resonance imaging and prostate‐specific antigen density outperforms individual co‐variables at predicting biopsy upgrading in patients on active surveillance for low risk prostate cancer. Cancer Rep (Hoboken) 2021; 5:e1492. [PMID: 34931468 PMCID: PMC8955055 DOI: 10.1002/cnr2.1492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/29/2021] [Accepted: 06/17/2021] [Indexed: 11/10/2022] Open
Abstract
Background Active surveillance (AS) is the reference standard treatment for the management of low risk prostate cancer (PCa). Accurate assessment of tumor aggressiveness guides recruitment to AS programs to avoid conservative treatment of intermediate and higher risk patients. Nevertheless, underestimating the disease risk may occur in some patients recruited, with biopsy upgrading and the concomitant potential for delayed treatment. Aim To evaluate the accuracy of mpMRI and GPS for the prediction of biopsy upgrading during active surveillance (AS) management of prostate cancer (PCa). Method A retrospective analysis was performed on 144 patients recruited to AS from October 2013 to December 2020. Median follow was 4.8 (IQR 3.6, 6.3) years. Upgrading was defined as upgrading to biopsy grade group ≥2 on follow up biopsies. Cox proportional hazard regression was used to investigate the effect of PSA density (PSAD), baseline Prostate Imaging‐Reporting and Data System (PI‐RADS) v2.1 score and GPS on upgrading. Time‐to‐event outcome, defined as upgrading, was estimated using the Kaplan–Meier method with log‐rank test. Results Overall rate of upgrading was 31.9% (n = 46). PSAD was higher in the patients who were upgraded (0.12 vs. 0.08 ng/ml2, p = .005), while no significant difference was present for median GPS in the overall cohort (overall median GPS 21; 22 upgrading vs. 20 no upgrading, p = .2044). On univariable cox proportional hazard regression analysis, the factors associated with increased risk of biopsy upgrading were PSA (HR = 1.30, CI 1.16–1.47, p = <.0001), PSAD (HR = 1.08, CI 1.05–1.12, p = <.0001) and higher PI‐RADS score (HR = 3.51, CI 1.56–7.91, p = .0024). On multivariable cox proportional hazard regression analysis, only PSAD (HR = 1.10, CI 1.06–1.14, p = <.001) and high PI‐RADS score (HR = 4.11, CI 1.79–9.44, p = .0009) were associated with upgrading. A cox regression model combining these three clinical features (PSAD ≥0.15 ng/ml2 at baseline, PI‐RADS Score and GPS) yielded a concordance index of 0.71 for the prediction of upgrading. Conclusion In this study PSAD has higher accuracy over baseline PI‐RADS score and GPS score for the prediction of PCa upgrading during AS. However, combined use of PSAD, GPS and PI‐RADS Score yielded the highest predictive ability with a concordance index of 0.71.
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Affiliation(s)
- Alp Tuna Beksac
- Department of Urology Icahn School of Medicine at Mount Sinai New York USA
| | - Parita Ratnani
- Department of Urology Icahn School of Medicine at Mount Sinai New York USA
| | - Zachary Dovey
- Department of Urology Icahn School of Medicine at Mount Sinai New York USA
| | - Sneha Parekh
- Department of Urology Icahn School of Medicine at Mount Sinai New York USA
| | - Ugo Falagario
- Department of Urology Icahn School of Medicine at Mount Sinai New York USA
| | - Reza Roshandel
- Department of Urology Icahn School of Medicine at Mount Sinai New York USA
| | - Stanislaw Sobotka
- Department of Urology Icahn School of Medicine at Mount Sinai New York USA
| | - Deepshikha Kewlani
- Department of Urology Icahn School of Medicine at Mount Sinai New York USA
| | - Avery Davis
- Department of Urology Icahn School of Medicine at Mount Sinai New York USA
| | - Rachel Weil
- Department of Urology Icahn School of Medicine at Mount Sinai New York USA
| | - Hafis Bashorun
- Department of Urology Icahn School of Medicine at Mount Sinai New York USA
| | - Ivan Jambor
- Department of Radiology Icahn School of Medicine at Mount Sinai New York USA
| | - Sara Lewis
- Department of Radiology Icahn School of Medicine at Mount Sinai New York USA
| | - Kenneth Haines
- Department of Pathology Icahn School of Medicine at Mount Sinai New York USA
| | - Ashutosh K. Tewari
- Department of Urology Icahn School of Medicine at Mount Sinai New York USA
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Beksac AT, Wilson CA, Lenfant L, Kim S, Aminsharifi A, Zeinab MA, Kaouk J. Single-Port Mini-Pfannenstiel Robotic Pyeloplasty: Establishing a Non-Narcotic Pathway Along with A Same-Day Discharge Protocol. Urology 2021; 160:130-135. [PMID: 34710396 DOI: 10.1016/j.urology.2021.10.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 07/17/2021] [Revised: 10/10/2021] [Accepted: 10/14/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To analyze the feasibility of a same day discharge protocol following SP robotic pyeloplasty. PATIENTS AND METHODS From a single institution series, 23 patients (12 multi-port (MP), 11 single-port (SP)) who underwent primary robotic dismembered pyeloplasty between February 2018 and March 2021 were analyzed. The association between baseline and perioperative characteristics with functional outcome was analyzed using, chi-square, Fisher's exact, Mann Whitney U and t-tests. RESULTS All SP cases were completed using the mini Pfannenstiel incision without the need for conversion or additional ports. Baseline characteristics were comparable. No intraoperative complications were seen. Only one patient in the SP group had a Clavien II complication. All patients in the MP group had a drain placed, whereas drain was not placed in the SP group. Length of stay was shorter in the SP group (11.4 vs. 42.6 hours, p<0.001). Although visual analog pain score was comparable at discharge (p=0.633), the SP group had lower opioid usage (morphine milligram equivalent) in the hospital (p<0.001) and a lower rate of opioid prescription during discharge (18.2% vs. 91.7% p<0.001). At a median follow-up of 8 months, no patients had flank pain and all patients had good kidney drainage on follow-up images. CONCLUSIONS Single-port robotic dismembered pyeloplasty through a mini-Pfannenstiel access allows a same-day discharge protocol with minimal opiate use.
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Affiliation(s)
- Alp Tuna Beksac
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Clark A Wilson
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Louis Lenfant
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Soodong Kim
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ali Aminsharifi
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mahmoud Abou Zeinab
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
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Lenfant L, Corrigan D, Beksac AT, Schwen Z, Kaouk J. Learning curve analysis of single-port robot-assisted extraperitoneal prostatectomy using the cumulative sum (CUSUM) method. BJU Int 2021; 128:688-691. [PMID: 34487399 DOI: 10.1111/bju.15588] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/26/2021] [Accepted: 09/02/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Louis Lenfant
- Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, OH, USA.,Urology Department, Hôpital Pitié-Salpêtrière, GRC n°5, PREDICTIVE ONCO-UROLOGY, AP-HP, Sorbonne University, Paris, France
| | - Dillon Corrigan
- Department of Quantitative Health Sciences, Cleveland Clinic, Lerner Research Institute, Cleveland, OH, USA
| | - Alp Tuna Beksac
- Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, OH, USA
| | - Zeyad Schwen
- Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, OH, USA
| | - Jihad Kaouk
- Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, OH, USA
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22
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Beksac AT, Eltemamy M, Hemal S, Schwen Z, Lenfant L, Abou Zeinab M, Aminsharifi A, Kaouk J. Single Port Donor Nephrectomy Via Modified Pfannenstiel Incision: Initial Preclinical Experience in A Cadaveric Model and Description of Technique. J Endourol 2021; 36:183-187. [PMID: 34314234 DOI: 10.1089/end.2021.0408] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To describe the surgical technique for the single port (SP) transperitoneal donor nephrectomy through a modified Pfannenstiel incision using the da Vinci SP surgical system (Intuitive Surgical, Sunnyvale, CA, USA) on a cadaver. PATIENTS & METHODS In a male cadaver, the SP surgical system was used to perform transperitoneal donor nephrectomy. A 3 cm modified Pfannenstiel incision was made. Through the incision GelPOINT mini (Applied Medical, Rancho Santa Margarita, CA, USA) was inserted. The floating docking technique was used. Through the gel port, the dedicated 25 mm multichannel port and a 12 mm assistant port were introduced. The surgical steps for donor nephrectomy were performed in the following order. 1) Mobilization of the colon, 2) Identification of psoas muscle, ureter, and the gonadal vein, 3) hilum dissection, 4) perirenal dissection, 5) stapling the renal artery and renal vein, 6) removal of the kidney through the enlarged incision. RESULTS Transperitoneal SP donor nephrectomy was completed without any complications or capsulotomy. Additional ports were not needed. The total operative time was 63 minutes and 54 seconds. A good-quality kidney was harvested. Renal artery length was 4 cm. CONCLUSION We demonstrated the feasibility of single-port transperitoneal donor nephrectomy via modified Pfannenstiel incision, using the novel SP robotic platform. Further assessment is necessary in a clinical setting.
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Affiliation(s)
- Alp Tuna Beksac
- Cleveland Clinic Glickman Urological and Kidney Institute, 273142, Urology, 9500 Euclid Avenue Q10, Cleveland, Ohio, United States, 44195-0001;
| | - Mohamed Eltemamy
- Cleveland Clinic Glickman Urological and Kidney Institute, 273142, Urology, Cleveland, Ohio, United States;
| | - Sij Hemal
- Cleveland Clinic Glickman Urological and Kidney Institute, 273142, Urology, 9500 Euclid Avenue, Glickman Urological and Kidney Institute, Cleveland, Ohio, United States, 44195-0001;
| | - Zeyad Schwen
- Cleveland Clinic Glickman Urological and Kidney Institute, 273142, Urology, Cleveland, Ohio, United States;
| | - Louis Lenfant
- Cleveland Clinic's Glickman Urological and Kidney Institute Department of Urology, 537826, 9500 Euclid avenue, Cleveland, Ohio, United States, 44195-0001.,Hopital Universitaire Pitie Salpetriere, 26933, Paris, France, 75651;
| | - Mahmoud Abou Zeinab
- Cleveland Clinic Glickman Urological and Kidney Institute, 273142, Urology, Cleveland, Ohio, United States;
| | | | - Jihad Kaouk
- Cleveland Clinic Foundation, Glickman Urologic Institute, 9500 Euclid Ave, Cleveland, Ohio, United States, 44195;
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Kaouk J, Beksac AT, Abou Zeinab M, Duncan A, Schwen ZR, Eltemamy M. Single Port Transvesical Robotic Radical Prostatectomy: Initial Clinical Experience and Description of Technique. Urology 2021; 155:130-137. [PMID: 34038749 DOI: 10.1016/j.urology.2021.05.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 04/29/2021] [Accepted: 05/09/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe our surgical technique and early results for the single port (SP) transvesical robotic radical prostatectomy using the da Vinci SP surgical system. PATIENTS & METHODS Twenty patients underwent SP radical prostatectomy through a transvesical approach. Through a 3 cm suprapubic incision, the bladder was incised and a GelPOINT mini system was used for floating docking. Through the gel port, the dedicated SP robotic port, a 12 mm assistant port, and a flexible suction tubing were introduced. RESULTS All cases were completed successfully without need for extra ports or conversion. No intraoperative complications were recorded. Median (IQR) total robotic time was 119 (99-127) minutes. Median (IQR) estimated blood loss was 135 (100-162) mL. Median (IQR) hospital length of stay was 4.4 (3.9-22.2) hours. None of the patients required opioids use after discharge. Median (IQR) time with a Foley catheter after surgery was 4 (4-6) days and 75% of the patients had immediate continence within 48 hours after Foley catheter removal. 85% were totally continent within 10 days after catheter removal. Three patients (15%) had positive surgical margins (all focal) on pathology. Two patients had transvesical lymph node dissection with 4 and 15 lymph nodes negative on final pathology. CONCLUSION We demonstrated the feasibility of SP robotic transvesical radical prostatectomy and pelvic lymph node dissection using a dedicated SP robotic platform. Favorable perioperative outcomes were seen, along with low complication rate, same day discharge, elimination of opioid requirement, and high rate of immediate recovery of continence as well as a low positive margin rate.
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Affiliation(s)
- Jihad Kaouk
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Alp Tuna Beksac
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Alisa Duncan
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Zeyad R Schwen
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Mohamed Eltemamy
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio
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Beksac AT, Okhawere KE, Meilika K, Ige OA, Lee JY, Lovallo GG, Ahmed M, Stifelman MD, Eun DD, Abaza R, Badani KK. Should a Drain Be Routinely Required After Transperitoneal Robotic Partial Nephrectomy? J Endourol 2020; 34:964-968. [PMID: 32597218 DOI: 10.1089/end.2020.0325] [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: 12/15/2022] Open
Abstract
Introduction: Closed drains have traditionally been placed after partial nephrectomy because of risks of bleeding and urine leak. We sought to study the safety of a nonroutine drain (NRD) approach after transperitoneal robotic partial nephrectomy (RPN). Patients and Methods: From a multi-institutional database, we have analyzed the data of 904 patients who underwent RPN. Five hundred forty-six (60.40%) patients underwent RPN by a surgeon who routinely placed drains. Three hundred fifty-eight (39.60%) patients underwent RPN by a surgeon who did not routinely placed drains. Perioperative outcomes, length of stay (LOS), and readmission rates were compared between the two groups. Baseline characteristics, perioperative, and postoperative outcomes were compared using Mann-Whitney U test, chi-square test, and Fisher's exact test. Results: Patients in the NRD group were more likely to have higher body mass index (30.10 kg/m2 vs 28.07 kg/m2; P < 0.001), higher tumor size (3.0 cm vs 2.5 cm; P = 0.001), and higher renal score (8 vs 7; P < 0.001). Rate of transfusion (0.00% NRD vs 0.56% RD; P = 0.157) and overall complication (7.33% NRD vs 7.82% RD; P = 0.782) were comparable. Median hospital stay is 1 day for both groups. Readmission rate was also similar (0.55% NRD vs 1.40% RD; P = 0.279). In a multivariable analysis, NRD approach was associated with shorter length of hospital stay (incidence rate ratio [IRR] - 0.72, P < 0.001). Conclusion: An NRD approach for RPN yielded a decreased LOS and similar perioperative outcomes. Placement of surgical drains should be based on individual circumstances, and not required on a routine basis.
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Affiliation(s)
- Alp Tuna Beksac
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kennedy E Okhawere
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kirolos Meilika
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Olajumoke A Ige
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jennifer Y Lee
- Department of Urology, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Gregory G Lovallo
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Mutahar Ahmed
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Michael D Stifelman
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Daniel D Eun
- Department of Urology, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Ronney Abaza
- OhioHealth Dublin Methodist Hospital, Columbus, Ohio, USA
| | - Ketan K Badani
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Beksac MS, Beksac AT, Tanacan A, Mumusoglu S, Katlan D, Celik HT. Antenatal hydronephrosis and fetal urine sampling. Congenit Anom (Kyoto) 2020; 60:4-9. [PMID: 30629771 DOI: 10.1111/cga.12324] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 11/30/2018] [Accepted: 01/03/2019] [Indexed: 11/29/2022]
Abstract
The aim of this study is to evaluate the significance of renal pelvis aspiration (RPA) in the management of antenatal hydronephrosis (AHN). This study enrolled 15 AHN cases (one twin pregnancy) that necessitated RPA for AHN. Chromosomal abnormalities, gene disorders, and additional life-threatening congenital abnormalities were eliminated prior to intrauterine interventions. Urine analysis were performed for the evaluation of renal function. Normal renal function was observed in six neonates/infants (40%) (group 1), whereas impaired renal function and various type of urinary system anomalies were observed in 9 neonates/infants (60%) (group 2) during the short-term and longitudinal follow-up periods. There were statistically significant differences in the oligohydroamniosis rate, mean fetal urine sodium value, mean fetal urine β2-microglobulin, mean gestational week at birth, and mean birthweight values between the groups (P = 0.007, P < 0.001, P = 0.035, P < 0.001, and P = 0.001, respectively). Renal pelvis aspiration and urine analysis were substantial for the management of AHN in necessary cases. β2-microglobulin and sodium are clinically useful markers to detect the presence of severe renal damage due to obstructive uropathy and thus, important adjuvants in the proper selection of fetuses for further antenatal interventions.
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Affiliation(s)
- Mehmet Sinan Beksac
- Division of Perinatology, Department of Obstetrics and Gynecology, Ankara, Turkey
| | | | - Atakan Tanacan
- Division of Perinatology, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Sezcan Mumusoglu
- Division of Perinatology, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Doruk Katlan
- Department of Obstetrics and Gynecology, Süleymaniye Research and Training Hospital, Istanbul, Turkey
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Beksac AT, Okhawere KE, Rosen DC, Elbakry A, Dayal BD, Daza J, Sfakianos JP, Ronney A, Eun DD, Bhandari A, Hemal AK, Porter J, Stifelman MD, Badani KK. Do patients with Stage 3-5 chronic kidney disease benefit from ischaemia-sparing techniques during partial nephrectomy? BJU Int 2019; 125:442-448. [PMID: 31758657 DOI: 10.1111/bju.14956] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 01/20/2023]
Abstract
OBJECTIVE To analyse whether selective arterial clamping (SAC) and off-clamp (OC) techniques during robot-assisted partial nephrectomy (RPN) are associated with a renal functional benefit in patients with Stage 3-5 chronic kidney disease (CKD). PATIENTS AND METHODS The change in estimated glomerular filtration rate (eGFR) over time was compared between 462 patients with baseline CKD 3-5 that underwent RPN with main arterial clamping (MAC) (n = 375, 81.2%), SAC (n = 48, 10.4%) or OC (n = 39, 8.4%) using a multivariable linear mixed-effects model. All follow-up eGFRs, including baseline and follow-up between 3 and 24 months, were included in the model for analysis. The median follow-up was 12.0 months (interquartile range 6.7-16.5; range 3.0-24.0 months). RESULTS In the multivariable linear mixed-effects model adjusting for characteristics including tumour size and the R.E.N.A.L. (Radius; Exophytic/Endophytic; Nearness; Anterior/Posterior; Location) Nephrometry Score, the change in eGFR over time was not significantly different between SAC and MAC RPN (β = -1.20, 95% confidence interval [CI] -5.45, 3.06; P = 0.582) and OC and MAC RPN (β = -1.57, 95% CI -5.21, 2.08; P = 0.400). Only 20 (15 MAC, two SAC, three OC) patients overall had progression of their CKD stage at last follow-up. The mean ischaemia time was 17 min for MAC and 15 min for SAC. There was no benefit to SAC or OC in terms of blood loss, perioperative complications, length of stay, or surgical margins. CONCLUSION SAC and OC techniques during RPN were not associated with benefit in preservation of eGFR in patients with baseline CKD.
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Affiliation(s)
- Alp Tuna Beksac
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kennedy E Okhawere
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daniel C Rosen
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Amr Elbakry
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bheesham D Dayal
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jorge Daza
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John P Sfakianos
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Abaza Ronney
- Robotic Urologic Surgery, OhioHealth Dublin Methodist Hospital, Columbus, OH, USA
| | - Daniel D Eun
- Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA
| | - Akshay Bhandari
- Division of Urology, Columbia University at Mount Sinai, Miami Beach, FL, USA
| | - Ashok K Hemal
- Department of Urology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | | | - Ketan K Badani
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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27
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Beksac AT, Orgul G, Tanacan A, Uckan H, Sancak B, Portakal O, Beksac MS. Uropathogens and Gestational Outcomes of Urinary Tract Infections in Pregnancies that Necessitate Hospitalization. Curr Urol 2019; 13:70-73. [PMID: 31768172 PMCID: PMC6873071 DOI: 10.1159/000499290] [Citation(s) in RCA: 5] [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] [Received: 08/15/2018] [Accepted: 10/08/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Our aim is to identify uropathogens that cause urinary tract infections (UTIs) that necessitate hospitalization, and analyze outcomes of gestational UTIs. METHODS This study consisted of 30 pregnant women who necessitate hospitalization because of UTI (7.8% of gestational UTIs during the same period of time). UTI that necessitates hospitalization is defined as clinical complaints, urination problems, urine analysis and culture positivity, fever and uterine discomfort. Patients with at least two positive cultures (≥ 100,000 cfu/ml) were included to this study. Antimicrobial susceptibility tests were obtained in all cases in order to determine antimicrobial resistance and to choose the ideal antibiotics for treatment. RESULTS In our study, we have found that Escherichia coli is the most common microorganism (56.7%). Enterococcus faecalis (13.3%) and Klebsiella pneumonia (10%) were other frequently observed microorganisms. In this series, mean gestational week at birth was 35 weeks 5 days (range 23-40 weeks). Mean birthweight was 2,656 g (range 500-3,700 g). Twenty-three cases (76.7%) were hospitalized before 37th gestational week and preterm delivery rate was 56.3%. Maternal risk factors and coexisting diseases were detected in 11 (36.7%) patients as follows: diabetes mellitus in 4, thrombophilia in 3, thyroid disorders in 3 and hydroureteronephrosis in 1 case. Cesarean section rate was 65.2%. CONCLUSIONS Knowing uropathogens of patient population is beneficial in the management of patients and better planning of future medical treatments. Preterm labor seems to be an important complication in pregnancies with UTIs going together with fever and urination problems.
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Affiliation(s)
- Alp Tuna Beksac
- Department of Urology, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Gokcen Orgul
- Division of Perinatology, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Atakan Tanacan
- Division of Perinatology, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Hasan Uckan
- Division of Perinatology, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Banu Sancak
- Department of Microbiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Oytun Portakal
- Department of Clinical Biochemistry, Hacettepe University School of Medicine, Ankara, Turkey
| | - Mehmet Sinan Beksac
- Division of Perinatology, Department of Obstetrics and Gynecology, Ankara, Turkey
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Jambor I, Falagario U, Ratnani P, Perez IM, Demir K, Merisaari H, Sobotka S, Haines GK, Martini A, Beksac AT, Lewis S, Pahikkala T, Wiklund P, Nair S, Tewari A. Prediction of biochemical recurrence in prostate cancer patients who underwent prostatectomy using routine clinical prostate multiparametric MRI and decipher genomic score. J Magn Reson Imaging 2019; 51:1075-1085. [PMID: 31566845 DOI: 10.1002/jmri.26928] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 08/26/2019] [Accepted: 08/27/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Biochemical recurrence (BCR) affects a significant proportion of patients who undergo robotic-assisted laparoscopic prostatectomy (RALP). PURPOSE To evaluate the performance of a routine clinical prostate multiparametric magnetic resonance imaging (mpMRI) and Decipher genomic classifier score for prediction of biochemical recurrence in patients who underwent RALP. STUDY TYPE Retrospective cohort study. SUBJECTS Ninety-one patients who underwent RALP performed by a single surgeon, had mpMRI before RALP, Decipher taken from RALP samples, and prostate specific antigen (PSA) follow-up for >3 years or BCR within 3 years, defined as PSA >0.2 mg/ml. FIELD STRENGTH/SEQUENCE: mpMRI was performed at 27 different institutions using 1.5T (n = 10) or 3T scanners and included T2 w, diffusion-weighted imaging (DWI), or dynamic contrast-enhanced (DCE) MRI. ASSESSMENT All mpMRI studies were reported by one reader using Prostate Imaging Reporting and Data System v. 2.1 (PI-RADsv2.1) without knowledge of other findings. Eighteen (20%) randomly selected cases were re-reported by reader B to evaluate interreader variability. STATISTICAL TESTS Univariate and multivariate analysis using greedy feature selection and tournament leave-pair-out cross-validation (TLPOCV) were used to evaluate the performance of various variables for prediction of BCR, which included clinical (three), systematic biopsy (three), surgical (six: RALP Gleason Grade Group [GGG], extracapsular extension, seminal vesicle invasion, intraoperative surgical margins [PSM], final PSM, pTNM), Decipher (two: Decipher score, Decipher risk category), and mpMRI (eight: prostate volume, PSA density, PI-RADv2.1 score, MRI largest lesion size, summed MRI lesions' volume and relative volume [MRI-lesion-percentage], mpMRI ECE, mpMRI seminal vesicle invasion [SVI]) variables. The evaluation metric was the area under the curve (AUC). RESULTS Forty-eight (53%) patients developed BCR. The best-performing individual features with TLPOCV AUC of 0.73 (95% confidence interval [CI] 0.64-0.82) were RALP GGG, MRI-lesion-percentage followed by biopsy GGG (0.72, 0.62-0.82), and Decipher score (0.71, 0.60-0.82). The best performance was achieved by feature selection of Decipher+Surgery and MRI + Surgery variables with TLPOCV AUC of 0.82 and 0.81, respectively DATA CONCLUSION: Relative lesion volume measured on a routine clinical mpMRI failed to outperform Decipher score in BCR prediction. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2020;51:1075-1085.
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Affiliation(s)
- Ivan Jambor
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, USA.,Department of Radiology, University of Turku, Turku, Finland.,Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Ugo Falagario
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Parita Ratnani
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ileana Montoya Perez
- Department of Radiology, University of Turku, Turku, Finland.,Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland.,Department of Future Technologies, University of Turku, Turku, Finland
| | - Kadir Demir
- Department of Future Technologies, University of Turku, Turku, Finland
| | - Harri Merisaari
- Department of Radiology, University of Turku, Turku, Finland.,Department of Future Technologies, University of Turku, Turku, Finland
| | - Stanislaw Sobotka
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - George K Haines
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alberto Martini
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alp Tuna Beksac
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sara Lewis
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Tapio Pahikkala
- Department of Future Technologies, University of Turku, Turku, Finland
| | - Peter Wiklund
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sujit Nair
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ash Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Sunaryo PL, Paulucci DJ, Okhawere K, Beksac AT, Sfakianos JP, Abaza R, Eun DD, Bhandari A, Hemal AK, Porter J, Badani KK. A multi-institutional analysis of 263 hilar tumors during robot-assisted partial nephrectomy. J Robot Surg 2019; 14:585-591. [DOI: 10.1007/s11701-019-01028-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 09/16/2019] [Indexed: 01/20/2023]
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30
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Daza J, Beksac AT, Kannappan M, Chong J, Abaza R, Hemal A, Sfakianos JP, Badani KK. Identifying tumor-related risk factors for simultaneous adrenalectomy in patients with cT1-cT2 kidney cancer during robotic assisted laparoscopic radical nephrectomy. Minerva Urol Nephrol 2019; 73:72-77. [PMID: 31166101 DOI: 10.23736/s2724-6051.19.03440-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND In some cases, preservation of adrenal gland could be at risk in patients with cT1 and cT2 RCC. The aim of this study was to evaluate tumor-related factors that can potentially increase the risk of simultaneous adrenalectomy during robotic-assisted laparoscopic radical nephrectomy (RALRN) in patients with cT1-cT2 disease and the impact of performing such procedure on recurrence-free survival (RFS) and complication rates. METHODS We used a multi-institutional kidney cancer database where we identified patients who underwent RALRN with or without adrenalectomy. We evaluated the tumor-related characteristics that could potentially increase the risk of adrenal gland resection of these patients. We also reported RFS at 12-24 months of follow-up, which was compared with an inverse probability of treatment weighted (IPTW) multivariable cox proportional hazards regression model and postoperative complications, which was compared with an IPTW multivariable logistic regression model. RESULTS Tumor size, cT stage, pT stage, histologic subtype, sarcomatoid differentiation, BMI, lymph node involvement, metastatic disease, Fuhrman grade do not increase the risk of simultaneous adrenalectomy during RALRN. Moreover, RALRN with adrenalectomy had no significant benefit in RFS. No differences in post-operative complications were noted. CONCLUSIONS Our evaluated tumor-related characteristics did not show to impact the incidence of simultaneous adrenalectomy. Adrenal gland resection T does not provide significant benefit in recurrence-free survival. We consider that RALRN with adrenalectomy should be reserved only for patients with adrenal compromise as stated previously regardless that it has shown to be a safe procedure.
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Affiliation(s)
- Jorge Daza
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA -
| | - Alp Tuna Beksac
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Muthumeena Kannappan
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Julio Chong
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ronney Abaza
- Robotic Urologic Surgery, OhioHealth Dublin Methodist Hospital, Columbus, OH, USA
| | - Ashok Hemal
- Department of Urology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - John P Sfakianos
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ketan K Badani
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Daza J, Beksac AT, Kannappan M, Chong J, Abaza R, Hemal A, Sfakianos JP, Badani KK. Identifying tumor-related risk factors for simultaneous adrenalectomy in patients with cT1-cT2 kidney cancer during robotic assisted laparoscopic radical nephrectomy. Minerva Urol Nephrol 2019. [PMID: 31166101 DOI: 10.23736/s0393-2249.19.03440-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND In some cases, preservation of adrenal gland could be at risk in patients with cT1 and cT2 RCC. The aim of this study was to evaluate tumor-related factors that can potentially increase the risk of simultaneous adrenalectomy during robotic-assisted laparoscopic radical nephrectomy (RALRN) in patients with cT1-cT2 disease and the impact of performing such procedure on recurrence-free survival (RFS) and complication rates. METHODS We used a multi-institutional kidney cancer database where we identified patients who underwent RALRN with or without adrenalectomy. We evaluated the tumor-related characteristics that could potentially increase the risk of adrenal gland resection of these patients. We also reported RFS at 12-24 months of follow-up, which was compared with an inverse probability of treatment weighted (IPTW) multivariable cox proportional hazards regression model and postoperative complications, which was compared with an IPTW multivariable logistic regression model. RESULTS Tumor size, cT stage, pT stage, histologic subtype, sarcomatoid differentiation, BMI, lymph node involvement, metastatic disease, Fuhrman grade do not increase the risk of simultaneous adrenalectomy during RALRN. Moreover, RALRN with adrenalectomy had no significant benefit in RFS. No differences in post-operative complications were noted. CONCLUSIONS Our evaluated tumor-related characteristics did not show to impact the incidence of simultaneous adrenalectomy. Adrenal gland resection T does not provide significant benefit in recurrence-free survival. We consider that RALRN with adrenalectomy should be reserved only for patients with adrenal compromise as stated previously regardless that it has shown to be a safe procedure.
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Affiliation(s)
- Jorge Daza
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA -
| | - Alp Tuna Beksac
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Muthumeena Kannappan
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Julio Chong
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ronney Abaza
- Robotic Urologic Surgery, OhioHealth Dublin Methodist Hospital, Columbus, OH, USA
| | - Ashok Hemal
- Department of Urology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - John P Sfakianos
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ketan K Badani
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Beksac AT, Sobotka S, Xu P, Gupta A, Treacy PJ, Weil R, Mahajan K, Prasad S, Cumarasamy S, Martini A, Falagario U, Rastinehad A, Tewari AK. Downgrading of Grade Group After Radical Prostatectomy: Comparison of Multiparametric Magnetic Resonance Imaging Guided Fusion Biopsy and Standard 12-Core Biopsy. Urology 2019; 127:80-85. [PMID: 30759371 DOI: 10.1016/j.urology.2019.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/31/2019] [Accepted: 02/04/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To analyze the factors associated with Grade group (GG) downgrading post-radical prostatectomy. PATIENTS AND METHODS We performed a retrospective analysis of 536 patients who underwent robot-assisted laparoscopic radical prostatectomy from February 2014 to October 2015. We have analyzed the clinical, radiological, and pathologic factors associated with GG downgrading in final pathology. Downgrading was defined as those patients who downgraded from GG 3, 4, or 5 on biopsy to GG 1 or 2 on final pathology as well as patients who downgraded from GG 2 on biopsy to GG 1 on final pathology. Categorical values were compared with chi-square and Fischer's exact tests. Mann-Whitney U and Kruskal-Wallis were used for analysis of independent variables associated with GG downgrading. RESULTS Ninety-three patients underwent fusion biopsy (FB) and 443 underwent the standard 12 core biopsy. Baseline clinical characteristics were similar between the 2 groups except for race (P = .009). Downgrading was observed in 76 patients (14.1%). Rate of downgrading was higher in the FB group (n = 22, 23.7% vs n = 54, 12.2%, P = .008). In multivariable logistic regression analysis, FB (OR:2.39, P = .004) and maximum percentage of core involvement (OR:1.01, P = .013) were associated with downgrading after robot-assisted laparoscopic radical prostatectomy. After 1:2 propensity score matching, FB was still associated with an increased rate of downgrading (P = .034). Downgrading had no significant effect on pathologic outcome. CONCLUSION FB and maximum percentage of core involvement are the only factors associated with GG downgrading in final pathology. However, downgrading did not influence surgical outcome.
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Affiliation(s)
- Alp Tuna Beksac
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Stanislaw Sobotka
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Paige Xu
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Akriti Gupta
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Rachel Weil
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Kanika Mahajan
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sonya Prasad
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Shivaram Cumarasamy
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alberto Martini
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ugo Falagario
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ardeshir Rastinehad
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ashutosh K Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY.
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Beksac AT, Bicak M, Paranjpe I, Paulucci DJ, Sfakianos JP, Badani KK. Clinicopathologic and Genomic Factors Associated With Oncologic Outcome in Patients With Stage III to IV Chromophobe Renal Cell Carcinoma. Clin Genitourin Cancer 2019; 17:e314-e322. [PMID: 30639042 DOI: 10.1016/j.clgc.2018.12.002] [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: 08/26/2018] [Revised: 11/15/2018] [Accepted: 12/03/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Chromophobe renal cell carcinoma (chRCC) is known as an indolent tumor; however, mortality still occurs. We sought to determine the clinicopathologic and genomic factors associated with aggressive chRCC. PATIENTS AND METHODS Two different datasets were used to identify patients with clinical stage III and IV chRCC. Eighteen patients from The Cancer Genome Atlas (TCGA) database and 1693 patients from the American College of Surgeons National Cancer Database (NCDB) were used for analysis. From the TCGA, RNA-Seq expression analysis of 18,745 genes was conducted between the recurrent (n = 5; 27.8%) and nonrecurrent patients (n = 13; 72.2%). Biological significance was identified via pathway enrichment and gene function analyses. From the NCDB, Cox proportion hazards regression models were used to identify variables associated with overall survival (OS) at a median follow-up of 41.4 months. RESULTS Between the 2 groups, 2182 genes were differentially expressed. The most commonly overexpressed pathways were neuroactive ligand-receptor interactions and cytokine-cytokine receptor interactions. The most activated gene functions were cellular, metabolic, and multicellular organismal processes. In the NCDB, multivariable analysis, age (hazard ratio [HR], 1.04; 95% confidence interval [CI], 1.03-1.05; P < .001), TNM stage IV versus III (HR, 3.86; 95% CI, 2.98-5.00; P < .001), and positive surgical margin (HR, 1.68; 95% CI, 1.45-1.96; P < .001) were associated with worse OS at a median follow-up of 41.4 months. Five-year OS was significantly lower for stage IV patients compared with stage III patients (80.0% vs. 29.9%; P < .001). CONCLUSIONS Patients with recurrent chRCC demonstrated a differential gene expression of specific biochemical pathways. Clinical parameters associated with worse OS included age, stage, and positive surgical margin.
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Affiliation(s)
- Alp Tuna Beksac
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Mesude Bicak
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ishan Paranjpe
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - David J Paulucci
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - John P Sfakianos
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ketan K Badani
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY.
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Beksac AT, Shah QN, Paulucci DJ, Lewis S, Taouli B, Badani KK. A Comparison of Excisional Volume Loss Calculation Methods to Predict Functional Outcome After Partial Nephrectomy. J Endourol 2019; 33:35-41. [DOI: 10.1089/end.2018.0639] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Alp Tuna Beksac
- Department of Urology and Icahn School of Medicine at Mount Sinai, New York, New York
| | - Qainat N. Shah
- Department of Urology and Icahn School of Medicine at Mount Sinai, New York, New York
| | - David J. Paulucci
- Department of Urology and Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sara Lewis
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Bachir Taouli
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ketan K. Badani
- Department of Urology and Icahn School of Medicine at Mount Sinai, New York, New York
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Chong JT, Paulucci D, Lubin M, Beksac AT, Gin G, Sfakianos JP, Badani KK. Comparison of overall survival and unplanned hospital readmissions between partial and radical nephrectomy for cT1a and cT1b renal masses. Ther Adv Urol 2018; 10:383-391. [PMID: 30574198 PMCID: PMC6295788 DOI: 10.1177/1756287218810313] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 10/11/2018] [Indexed: 11/17/2022] Open
Abstract
Background: The aim of the study was to compare overall survival (OS) and unplanned hospital readmissions (UHRs) within 30 days between partial nephrectomy (PN) and radical nephrectomy (RN) for clinically localized T1 renal tumors. Methods: The National Cancer Database was queried to identify 51,018 patients who had undergone RN (n = 23,904; 46.9%) or PN (n = 27,114; 53.1%) for a cT1N0M0 renal mass from 2004 to 2013. OS and UHRs were compared using inverse probability of treatment weighted (IPTW)-adjusted Cox proportional hazards regression models. Results: For patients with a cT1a tumor, IPTW-adjusted analysis showed PN compared with RN was associated with improved OS (hazard ratio [HR] = 0.62; 95% confidence interval [CI] = 0.56, 0.67; p < 0.001) with a 5-year and 10-year IPTW-adjusted OS of 93.0% versus 88.2% and 78.1% versus 71.7%, respectively with no difference in UHR (odds ratio [OR] = 1.02; 95% CI = 0.90, 1.16; p = 0.727). For patients with a cT1b tumor, IPTW-adjusted analysis showed PN compared with RN to be associated with marginally improved OS (HR = 0.89; 95% CI = 0.82, 0.99; p = 0.025) with a 5-year and 10-year IPTW-adjusted OS of 85.3% versus 84.3% and 70.8% versus 63.6%, respectively, with more UHRs for PN (OR = 1.43; 95% CI = 1.19, 1.72; p < 0.001). Conclusions: PN compared with RN was associated with a significant survival benefit for patients with a cT1a renal mass and a modest survival benefit for patients with a cT1b renal mass. PN should be offered over RN when feasible despite a marginal increase in UHRs for PN of cT1b tumors. Randomized controlled trials are necessary to confirm these findings.
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Affiliation(s)
- Julio T Chong
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - David Paulucci
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Marc Lubin
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Alp Tuna Beksac
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Greg Gin
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA, and Department of Urology, Veterans Affairs Long Beach Health System, Long Beach, CA, USA
| | - John P Sfakianos
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Ketan K Badani
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, 5 E 98th Street, New York, NY 10029, USA
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Beksac AT, Reddy BN, Martini A, Paulucci DJ, Moshier E, Abaza R, Eun DD, Hemal AK, Badani KK. Hypertension and diabetes mellitus are not associated with worse renal functional outcome after partial nephrectomy in patients with normal baseline kidney function. Int J Urol 2018; 26:120-125. [DOI: 10.1111/iju.13819] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 09/05/2018] [Indexed: 01/20/2023]
Affiliation(s)
- Alp Tuna Beksac
- Department of Urology; Icahn School of Medicine at Mount Sinai; New York City New York USA
| | - Balaji N Reddy
- Department of Urology; Icahn School of Medicine at Mount Sinai; New York City New York USA
| | - Alberto Martini
- Department of Urology; Icahn School of Medicine at Mount Sinai; New York City New York USA
| | - David J Paulucci
- Department of Urology; Icahn School of Medicine at Mount Sinai; New York City New York USA
| | - Erin Moshier
- The Tisch Cancer Institute; Icahn School of Medicine at Mount Sinai; New York City New York USA
| | - Ronney Abaza
- Robotic Urologic Surgery; Ohio Health Dublin Methodist Hospital; Dublin Ohio USA
| | - Daniel D Eun
- Department of Urology; Temple University School of Medicine; Philadelphia Pennsylvania USA
| | - Ashok K Hemal
- Department of Urology; Wake Forest School of Medicine; Winston-Salem North Carolina USA
| | - Ketan K Badani
- Department of Urology; Icahn School of Medicine at Mount Sinai; New York City New York USA
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Martini A, Cumarasamy S, Beksac AT, Abaza R, Eun DD, Bhandari A, Hemal AK, Porter JR, Badani KK. A Nomogram to Predict Significant Estimated Glomerular Filtration Rate Reduction After Robotic Partial Nephrectomy. Eur Urol 2018; 74:833-839. [PMID: 30224195 DOI: 10.1016/j.eururo.2018.08.037] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [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: 04/11/2018] [Accepted: 08/30/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Decreased functional outcome after partial nephrectomy is associated with overall mortality. OBJECTIVE To create a model that predicts ≥25% reduction from baseline estimated glomerular filtration rate (eGFR) in patients undergoing robot-assisted partial nephrectomy (RAPN) and to investigate the role of acute kidney injury (AKI) in this patient population. DESIGN, SETTING, AND PARTICIPANTS A total of 999 patients were identified from a multi-institutional database. Renal function was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines for chronic kidney disease (CKD). AKI was defined as >25% reduction in eGFR from pre-RAPN period to discharge. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS A nomogram to predict significant eGFR reduction (≥25% from baseline) in the time-frame between 3 and 15mo after RAPN was built based on the coefficients of Cox survival function that ultimately included age, sex, Charlson comorbidity index, baseline eGFR, RENAL nephrometry score, AKI in patients with normal baseline renal function, and AKI on CKD. Such landmark analysis was chosen in order to account for eGFR fluctuations occurring within the first 3mo of RAPN. The proportional hazard assumption was evaluated through the Schönfeld test. Internal validation was performed using the leave-one-out cross validation. Calibration was graphically investigated. The decision curve analysis (DCA) was used to evaluate the net clinical benefit. RESULTS AND LIMITATIONS Median (interquartile range [IQR]) age at surgery was 61yr (51, 68). Overall, 146 patients experienced significant eGFR reduction; median follow-up for survivors was 12.4mo. The 15-mo probability of significant eGFR reduction was 19%. All variables fitted into the model, including AKI in patients with normal renal function (hazard ratio [HR]: 4.51; 95% confidence interval [CI]: 3.12, 6.60; p<0.001) and AKI on CKD (HR: 4.90; 95% CI: 2.17, 11.1; p<0.001), emerged as predictors of significant eGFR reduction (all p≤0.048) and were considered to build a nomogram. The internally validated c index was 73%. The model demonstrated excellent calibration and a net benefit at the DCA with probabilities ≥4%. CONCLUSIONS We developed a nomogram that accurately predicts significant eGFR reduction after RAPN. This model may serve as a tool for early identification of patients at high risk for significant renal function decline after surgery. PATIENT SUMMARY We have developed a model for the prediction of renal function loss after partial nephrectomy for renal cancer.
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Affiliation(s)
- Alberto Martini
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA.
| | - Shivaram Cumarasamy
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Alp Tuna Beksac
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Ronney Abaza
- Robotic Urologic Surgery, OhioHealth Dublin Methodist Hospital, Columbus, OH, USA
| | - Daniel D Eun
- Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA
| | - Akshay Bhandari
- Division of Urology, Columbia University at Mount Sinai, Miami Beach, FL, USA
| | - Ashok K Hemal
- Department of Urology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Ketan K Badani
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA.
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Paulucci DJ, Beksac AT, Porter J, Abaza R, Eun DD, Bhandari A, Hemal AK, Badani KK. A Multi-Institutional Propensity Score Matched Comparison of Transperitoneal and Retroperitoneal Partial Nephrectomy for cT1 Posterior Tumors. J Laparoendosc Adv Surg Tech A 2018; 29:29-34. [PMID: 30106606 DOI: 10.1089/lap.2018.0313] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 12/13/2022] Open
Abstract
OBJECTIVE To compare the perioperative and renal functional outcome between transperitoneal and retroperitoneal robotic partial nephrectomy (TP-RPN and RP-RPN) in the largest cohort to date of RP-RPN for posterior tumors. METHODS We identified 519 patients who met eligibility criteria and underwent TP-RPN (n = 357, 68.8%) or RP-RPN (n = 162, 31.2%) for a posteriorly located cT1 tumor. Patients were propensity score (PS) matched on preoperative and tumor-specific characteristics. Perioperative outcome and renal function outcome at median follow-up 22 months were compared. RESULTS Between the PS matched TP-RPN (n = 157, 50%) and RP-RPN (n = 157, 50%) patients, operative time (OT) (185.0 versus 157.0, P < .001) was longer in TP-RPN versus RP-RPN patients. No significant differences in ischemia time (P = .618), blood loss (P = .178), positive surgical margins (P = .501), overall postoperative complications (P = .861), or progression of chronic kidney disease stage at median 22 months (P = .599) were identified. Length of stay (LOS) was reduced in RP-RPN patients (P = .017), but was not different once an institution used a postoperative day (POD)-1 discharge protocol (P = .579). Operative times were similar between groups in patients with obesity (P = .293) or a cT1b renal mass (P = 908). CONCLUSION RP-RPN for posterior tumors resulted in reduced OT and a shorter LOS compared to TP-RPN. When surgeons aimed to routinely discharge patients on POD-1, the surgical approach did not influence LOS. Operative time was similar between RP and TP-RPN among patients with obesity or a cT1b renal mass. All other measures, including ischemia time, blood loss, margin rates, complications, and renal function, did not differ between the two approaches.
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Affiliation(s)
- David J Paulucci
- 1 Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alp Tuna Beksac
- 1 Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - James Porter
- 2 Department of Urology, Swedish Urology Group, Seattle, Washington
| | - Ronney Abaza
- 3 Robotic Urologic Surgery, OhioHealth Dublin Methodist Hospital, Columbus, Ohio
| | - Daniel D Eun
- 4 Department of Urology, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Akshay Bhandari
- 5 Division of Urology, Columbia University at Mount Sinai, Miami Beach, Florida
| | - Ashok K Hemal
- 6 Department of Urology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Ketan K Badani
- 1 Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York
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Kaldany A, Blum KA, Paulucci DJ, Beksac AT, Jayaratna I, Sfakianos JP, Badani KK. An evaluation of race, ethnicity, age, and sex-based representation in phase I to II renal cell carcinoma clinical trials in the United States. Urol Oncol 2018; 36:363.e1-363.e6. [DOI: 10.1016/j.urolonc.2018.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/06/2018] [Accepted: 05/08/2018] [Indexed: 11/16/2022]
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Beksac MS, Beksac AT, Buyukeren M, Tanacan A, Bektas H, Gucer S. Are Congenital Urinary Tract Abnormalities Linked to Maternal Methylenetetrahydrofolate Reductase Polymorphisms in Fetuses of Intentionally Terminated Pregnancies with Oligo- or Anhydramnios ? Fetal Pediatr Pathol 2018; 37:177-183. [PMID: 29737941 DOI: 10.1080/15513815.2018.1461283] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE We aimed to evaluate fetuses of terminated pregnancies with oligo-or anhydramnios (OAH) to further investigate the association between maternal methylenetetrahydrofolate reductase (MTHFR) polymorphisms and fetal urinary tract malformations. MATERIALS AND METHODS This retrospective study included 16 pregnancies with OAH (with normal fetal karyotype) that were intentionally terminated before 22nd gestational week. Fetal autopsy was performed in all cases. We evaluated cases for presence of DNA methylation pathway-related gene polymorphisms. RESULTS We demonstrated that renal abnormalities and disorders exist in 75% of the cases. Pulmonary system anomalies and single umbilical artery were the most frequently observed associated abnormalities. Polymorphisms with known reduced MTHFR activity were found in 81.8% (9/11) of the cases.Association between urinary system abnormalities and polymorphisms with known reduced MTHFR activity was observed in 88.8% (8/9) of the cases. CONCLUSION Physicians should keep in mind that polymorphisms with known reduced MTHFR activity may be associated with urinary tract abnormalities and OAH.
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Affiliation(s)
- M Sinan Beksac
- a Division of Perinatology, Department of Obstetrics and Gynecology , Hacettepe University , Ankara , Turkey
| | - Alp Tuna Beksac
- b Department of Urology , Hacettepe University , Ankara , Turkey
| | - Melek Buyukeren
- c Division of Neonatology, Department of Pediatrics , Hacettepe University , Ankara , Turkey
| | - Atakan Tanacan
- d Division of Perinatology, Department of Obstetrics and Gynecology , Hacettepe University , Ankara , Turkey
| | - Hatice Bektas
- e Department of Pediatrics , Hacettepe University , Ankara , Turkey
| | - Safak Gucer
- f Division of Pediatric Pathology, Department of Pediatrics , Hacettepe University , Ankara , Turkey
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Badani KK, Reddy BN, Moskowitz EJ, Paulucci DJ, Beksac AT, Martini A, Whalen MJ, Skarecky DW, Huynh LM, Ahlering TE. Lymph node yield during radical prostatectomy does not impact rate of biochemical recurrence in patients with seminal vesicle invasion and node-negative disease. Urol Oncol 2018; 36:310.e1-310.e6. [PMID: 29625782 DOI: 10.1016/j.urolonc.2018.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 12/04/2017] [Revised: 02/05/2018] [Accepted: 03/05/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Seminal vesicle invasion (SVI) is a risk factor for poor oncologic outcome in patients with prostate cancer. Modifications to the pelvic lymph node dissection (PLND) during radical prostatectomy (RP) have been reported to have a therapeutic benefit. The present study is the first to determine if lymph node yield (LNY) is associated with a lower risk of biochemical recurrence (BCR) for men with SVI. METHODS A total of 220 patients from 2 high-volume institutions who underwent RP without adjuvant treatment between 1990 and 2015 and had prostate cancer with SVI (i.e., pT3b) were identified, and 21 patients did not undergo lymph node dissection. BCR was defined as a postoperative PSA>0.2ng/mL, or use of salvage androgen deprivation therapy (ADT) or radiation. Multivariable Cox proportional hazards models were used to determine whether LNY was predictive of BCR, controlling for PSA, pathologic Gleason Score, pathologic lymph node status, NCCN risk category, etc. The Kaplan-Meier method was used to determine 3-year freedom from BCR. RESULTS Median number of lymph nodes sampled were 7 (IQR: 3-12; range: 0-35) and 90.5% underwent PLND. The estimated 3-year BCR rate was 43.9%. Results from multivariable analysis demonstrated that LNY was not significantly associated with risk of BCR overall (HR = 1.00, 95% CI: 0.98-1.03; P = 0.848) for pN0 (HR = 0.99, 95% CI: 0.97-1.03; P = 0.916) or pN1 patients (HR = 0.96, 95% CI: 0.88-1.06; P = 0.468). Overall, PSA (HR = 1.02, P<0.001) and biopsy Gleason sum ≥ 8 (HR = 1.81, P = 0.001) were associated with an increased risk of BCR, and increasing LNY increased the likelihood of detecting>2 positive lymph nodes (OR = 1.27, 95% CI: 1.06-1.65, P = 0.023). CONCLUSION Seminal vesicle invasion is associated with an increased risk of BCR at 3 years, primarily due to pathologic Gleason score and PSA. Although greater lymph node yield is diagnostic and facilitates more accurate pathologic staging, our data do not show a therapeutic benefit in reducing BCR.
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Affiliation(s)
- Ketan K Badani
- Department of Urology, Icahn School of Medicine, Mount Sinai, New York, NY
| | - Balaji N Reddy
- Department of Urology, Icahn School of Medicine, Mount Sinai, New York, NY
| | - Eric J Moskowitz
- Department of Urology, Icahn School of Medicine, Mount Sinai, New York, NY
| | - David J Paulucci
- Department of Urology, Icahn School of Medicine, Mount Sinai, New York, NY
| | - Alp Tuna Beksac
- Department of Urology, Icahn School of Medicine, Mount Sinai, New York, NY
| | - Alberto Martini
- Department of Urology, Icahn School of Medicine, Mount Sinai, New York, NY
| | - Michael J Whalen
- Department of Urology, Icahn School of Medicine, Mount Sinai, New York, NY
| | | | - Linda My Huynh
- Department of Urology, University of California-Irvine, Orange, CA
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Falagario UG, Beksac AT, Cumarasamy S, Xu P, Martini A, Gupta A, Mahajan K, Jayaratna I, Tewari A. PD60-04 DEFINING A FAVORABLE INTERMEDIATE-RISK GROUP: UTILITY OF MAGNETIC RESONANCE IMAGING AND GENETIC TESTS. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.2816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Anastos H, Paulucci D, Beksac AT, Waingankar N, Patel H, Gin G, Sfakianos J, Badani K. MP36-19 FACTORS DRIVING WORSE SURVIVAL BETWEEN BLACK AND WHITE PATIENTS WITH RENAL CELL CARCINOMA. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Beksac AT, Rosen D, Paulucci D, Sfakianos J, Abaza R, Eun D, Bhandari A, Hemal A, Porter J, Badani K. PD16-01 DO ISCHEMIA SPARING TECHNIQUES BENEFIT RENAL FUNCTION IN PATIENTS WITH STAGE III-V CHRONIC KIDNEY DISEASE UNDERGOING PARTIAL NEPHRECTOMY? J Urol 2018. [DOI: 10.1016/j.juro.2018.02.813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Beksac AT, Falagario U, Cumarasamy S, Gupta A, Xu P, Prasad S, Martini A, Thulasidass H, Jayaratna I, Rastinehad A, Tewari A. MP14-17 ROLE OF MAGNETIC RESONANCE IMAGING IN PREDICTING ADVERSE PATHOLOGY POST-RADICAL PROSTATECTOMY. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kaldany A, Paulucci D, Anastos H, Beksac AT, Sfakianos J, Badani K. MP66-05 CLINICOPATHOLOGICAL AND SURVIVAL ANALYSIS OF STAGE III/IV PAPILLARY AND CHROMOPHOBE RENAL CELL CARCINOMA: IMPLICATIONS FOR FUTURE CLINICAL TRIALS. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Patel H, Khan I, Paulucci D, Beksac AT, Waingankar N, Sfakianos J, Badani K. MP51-14 TRENDS AND PREDICTORS OF ACTIVE SURVEILLANCE USE IN THE UNITED STATES FOR PATIENTS WITH CLINICAL T1 RENAL MASSES. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Paulucci D, Rothberg MB, Beksac AT, Abaza R, Eun D, Hemal A, Badani K. MP59-11 A COMPARISON OF ONCOLOGIC OUTCOME BETWEEN RADICAL AND PARTIAL NEPHRECTOMY FOR INCIDENTALLY UPSTAGED PT3A RENAL TUMORS. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Beksac AT, Paulucci D, Sfakianos JP, Mehrazin R, Abaza R, Eun D, Badani K. MP66-04 COMPARISON OF ROBOTIC AND OPEN TECHNIQUES IN PATIENTS UNDERGOING RADICAL NEPHRECTOMY AND LEVEL II/III INFERIOR VENA CAVA THROMBECTOMY. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Khan I, Beksac AT, Paulucci DJ, Abaza R, Eun DD, Bhandari A, Badani KK. Differences in Renal Tumor Size Measurements for Computed Tomography Versus Magnetic Resonance Imaging: Implications for Patients on Active Surveillance. J Laparoendosc Adv Surg Tech A 2017; 27:1275-1278. [PMID: 28799884 DOI: 10.1089/lap.2017.0234] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 12/31/2022] Open
Abstract
PURPOSE To evaluate and compare the accuracy of computed tomography (CT) and magnetic resonance imaging (MRI) in predicting the final pathologic tumor size of partial nephrectomy specimens. MATERIALS AND METHODS We analyzed a multi-institutional database of 807 patients who underwent robotic partial nephrectomy for a cT1a renal mass from 2006 to 2016. Patients who had a solitary tumor with complete data on the baseline imaging modality and the tumor size (baseline and pathologic) (n = 349) were included for analysis. Baseline tumor size evaluated by both imaging modalities, in addition to the difference between the measurements and final pathologic tumor size (cm) measurements, was compared between patients who received a baseline CT (n = 276, 79.1%) and those who received an MRI (n = 73, 20.9%). RESULTS There were no statistically significant differences between any baseline characteristics and receipt of a CT versus MRI. In multivariable analysis adjusting for confounders, there was no significant difference in the baseline tumor size between patients receiving an MRI and those receiving a CT (2.3 versus 2.6 cm; β = -0.13; 95% confidence interval [CI] = -0.33 to 0.07; P = .208). Tumor size on imaging was smaller from final pathology by 0.43 cm on average (P = .002). Measurement error for the measured baseline versus actual pathologic tumor size did not significantly differ for patients receiving an MRI versus those receiving a CT (0.38 versus 0.44 cm; β = -0.06; 95% CI = -0.16 to 0.04; P = .232). CONCLUSION Baseline renal tumor size measurements were not significantly different for CT scan and MRI. Choice of imaging modality can be based on doctor and patient preference, including cost and exposure to radiation.
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Affiliation(s)
- Irtaza Khan
- 1 Department of Urology, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Alp Tuna Beksac
- 1 Department of Urology, Icahn School of Medicine at Mount Sinai , New York, New York
| | - David J Paulucci
- 1 Department of Urology, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Ronney Abaza
- 2 Department of Urology, OhioHealth Dublin Methodist Hospital , Columbus, Ohio
| | - Daniel D Eun
- 3 Department of Urology, Temple University School of Medicine , Philadelphia, Pennsylvania
| | - Akshay Bhandari
- 4 Department of Urology, Division of Urology, Columbia University at Mount Sinai , Miami Beach, Florida
| | - Ketan K Badani
- 1 Department of Urology, Icahn School of Medicine at Mount Sinai , New York, New York
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