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Schiffmann J, Haese A, Leyh-Bannurah SR, Salomon G, Steuber T, Schlomm T, Boehm K, Beyer B, Larcher A, Michl U, Heinzer H, Huland H, Graefen M, Karakiewicz PI. Adherence of the indication to European Association of Urology guideline recommended pelvic lymph node dissection at a high-volume center: Differences between open and robot-assisted radical prostatectomy. Eur J Surg Oncol 2015; 41:1547-53. [PMID: 26117216 DOI: 10.1016/j.ejso.2015.05.008] [Citation(s) in RCA: 10] [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] [Received: 12/07/2014] [Revised: 04/01/2015] [Accepted: 05/19/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE Contemporary adherence of the indication to European Association of Urology (EAU) guideline recommendation for pelvic lymph node dissection (PLND) at either open (ORP) or robot-assisted radical prostatectomy (RARP) at a high-volume center is unknown. To assess guideline recommended and observed PLND rates in a high-volume center cohort. METHODS We relied on the Martini-Clinic database and focused on patients treated with either ORP or RARP, between 2010 and 2013. Actual performed PLND was compared to European Association of Urology (EAU) guideline recommendation defined by nomogram predicted risk of lymph node invasion >5%. Categorical and multivariable logistic regression analyses targeted two endpoints: 1) probability of guideline recommended PLND and 2) probability of no PLND, when not recommended by EAU guideline. RESULTS Within 7868 PCa patients, adherence to EAU PLND guideline recommendation was 97.1% at ORP and 96.8% at RARP (p = 0.7). When PLND was not recommended, it was more frequently performed at RARP (71.6%) than at ORP (66.2%) (p = 0.002). Gleason score, PSA and number of positive biopsy cores were independent predictors for both either PLND when recommended, or no PLND when not recommended (all p < 0.05). Clinical tumor stage, age and surgical approach were also independent predictors for no PLND when not recommended (all p < 0.05). CONCLUSIONS Adherence of the indication to EAU guideline recommended PLND is high at this high-volume center. Neither ORP nor RARP represent a barrier for PLND, when recommended. However, a high number of patients underwent PLND despite absence of guideline recommendation. Possible staging advantages and PLND related complications needs to be individually considered, especially, when LNI risk is low.
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Affiliation(s)
- J Schiffmann
- Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany; Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.
| | - A Haese
- Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - G Salomon
- Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - T Steuber
- Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - T Schlomm
- Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - K Boehm
- Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany; Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada
| | - B Beyer
- Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Larcher
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Department of Urology, Vita-Salute San Raffaele University, Milan, Italy
| | - U Michl
- Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - H Heinzer
- Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - H Huland
- Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Graefen
- Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - P I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Department of Urology, University of Montreal Health Center, Montreal, Canada
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Larcher A, Sun M, Schiffmann J, Tian Z, Shariat S, McCormack M, Saad F, Fossati N, Abdollah F, Briganti A, Buffi N, Graefen M, Guazzoni G, Montorsi F, Karakiewicz P. Differential effect on survival of pelvic lymph node dissection at radical cystectomy for muscle invasive bladder cancer. European Journal of Surgical Oncology (EJSO) 2015; 41:353-60. [DOI: 10.1016/j.ejso.2014.10.061] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 10/16/2014] [Accepted: 10/24/2014] [Indexed: 10/24/2022]
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Schiffmann J, Gandaglia G, Larcher A, Sun M, Tian Z, Shariat SF, McCormack M, Valiquette L, Montorsi F, Graefen M, Saad F, Karakiewicz PI. Contemporary 90-day mortality rates after radical cystectomy in the elderly. Eur J Surg Oncol 2014; 40:1738-45. [PMID: 25454826 DOI: 10.1016/j.ejso.2014.10.004] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Revised: 09/28/2014] [Accepted: 10/06/2014] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Existing radical cystectomy (RC) perioperative mortality estimates may underestimate the contemporary rates due to more advanced age, more baseline comorbidities and potentially broader inclusion criteria for RC, relative to past criteria. METHODS Within the most recent Surveillance, Epidemiology, and End Results (SEER)-Medicare database we identified clinically non-metastatic, muscle-invasive (T2-T4a) urothelial carcinoma of the urinary bladder (UCUB) patients, who underwent RC between 1991 and 2009. Mortality at 30- and 90-day after RC was quantified. Multivariable logistic regression analyses tested predictors of 90-day mortality. RESULTS Within 5207 assessable RC patients 30- and 90-day mortality rates were 5.2 and 10.6%, respectively. According to age 65-69, 70-79 and ≥ 80 years, 90-day mortality rates were 6.4, 10.1 and 14.8% (p < 0.001). Additionally, 90-day mortality rates increased with increasing Charlson Comorbidity Index (CCI, 0, 1, 2 and ≥ 3): 6.3, 10.3, 12.6 and 15.9% (p < 0.001). 90-day mortality rate in unmarried patients was 13.0 vs. 9.3% in married individuals (p < 0.001). In multivariable logistic regression analyses, advanced age, higher CCI, low socioeconomic status, unmarried status and non organ-confined stage were independent predictors of 90-day mortality (all p < 0.05). CONCLUSIONS The contemporary SEER-Medicare derived 90-day mortality rates are substantially higher than previously reported estimates from centers of excellence, and even exceed previous SEER reports. More advanced age, higher CCI score, and other patient characteristics that distinguish the current population from others account for these differences.
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Affiliation(s)
- J Schiffmann
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Martini-Clinic Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - G Gandaglia
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Department of Urology, Vita-Salute San Raffaele University, Milan, Italy
| | - A Larcher
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Department of Urology, Vita-Salute San Raffaele University, Milan, Italy
| | - M Sun
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada
| | - Z Tian
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada
| | - S F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - M McCormack
- Department of Urology, University of Montreal Health Center, Montreal, Canada
| | - L Valiquette
- Department of Urology, University of Montreal Health Center, Montreal, Canada
| | - F Montorsi
- Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Department of Urology, Vita-Salute San Raffaele University, Milan, Italy
| | - M Graefen
- Martini-Clinic Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - F Saad
- Department of Urology, University of Montreal Health Center, Montreal, Canada
| | - P I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Department of Urology, University of Montreal Health Center, Montreal, Canada
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Boehm K, Beyer B, Tennstedt P, Schiffmann J, Budaeus L, Haese A, Graefen M, Schlomm T, Heinzer H, Salomon G. No impact of blood transfusion on oncological outcome after radical prostatectomy in patients with prostate cancer. World J Urol 2014; 33:801-6. [DOI: 10.1007/s00345-014-1351-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Accepted: 06/19/2014] [Indexed: 10/25/2022] Open
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Schiffmann J, Tennstedt P, Fischer J, Tian Z, Beyer B, Boehm K, Sun M, Gandaglia G, Michl U, Graefen M, Salomon G. Does HistoScanning™ predict positive results in prostate biopsy? A retrospective analysis of 1,188 sextants of the prostate. World J Urol 2014; 32:925-30. [PMID: 24871425 DOI: 10.1007/s00345-014-1330-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 05/19/2014] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The role of HistoScanning™ (HS) in prostate biopsy is still indeterminate. Existing literature is sparse and controversial. To provide more evidence according to that important clinical topic, we analyzed institutional data from the Martini-Clinic, Prostate Cancer Center, Hamburg. METHODS Patients who received prostate biopsy and who also received HS were included in the study cohort. A single examiner, blinded to pathological results, re-analyzed all HS data in accordance with sextants of the prostate. Each sextant was considered as an individual case. Corresponding results from biopsy and HS were analyzed. The area under the receiver-operating characteristic curve (AUC) for the prediction of a positive biopsy by HS was calculated. Furthermore, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were assessed according to different HS signal volume cutoffs (>0, >0.2 and >0.5 ml). RESULTS Overall, 198 men were identified and 1,188 sextants were analyzed. The AUC to predict positive biopsy results by HS was 0.58. Sensitivity, specificity, PPV and NPV for HS to predict positive biopsy results per sextant, depending on different HS signal volume cutoffs (>0, >0.2 and >0.5 ml) were 84.1, 27.7, 29.5 and 82.9 %, 60.9, 50.6, 28.8 and 79.7 %, and 40.1, 73.3, 33.1 and 78.8 %, respectively. CONCLUSIONS Positive HS signals do not accurately predict positive prostate biopsy results according to sextant analysis. We cannot recommend a variation of well-established random biopsy patterns or reduction of biopsy cores in accordance with HS signals at the moment.
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Affiliation(s)
- J Schiffmann
- Martini-Clinic, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,
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Gandaglia G, Karakiewicz P, Briganti A, Trinh Q, Schiffmann J, Tian Z, Kim S, Nguyen P, Graefen M, Montorsi F, Sun M, Abdollah F. Intensity-modulated radiation therapy leads to survival benefit only in patients with high-risk prostate cancer: a population-based study. Ann Oncol 2014; 25:979-86. [DOI: 10.1093/annonc/mdu087] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Roiss M, Schiffmann J, Tennstedt P, Kessler T, Blanc I, Goetz A, Schlomm T, Graefen M, Reuter DA. Oncological long-term outcome of 4772 patients with prostate cancer undergoing radical prostatectomy: does the anaesthetic technique matter? Eur J Surg Oncol 2014; 40:1686-92. [PMID: 24613743 DOI: 10.1016/j.ejso.2014.02.223] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [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: 11/20/2013] [Revised: 01/31/2014] [Accepted: 02/07/2014] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Recent data suggest that using additional neuroaxial anaesthesia during oncological surgery is associated with favourable recurrence-free survival, when compared with general anaesthesia alone. We assessed the impact of adjunctive perioperative spinal anaesthesia and dose of opioids on the oncological long-term outcome of patients following radical prostatectomy. METHODS We selected patients from our institutional review board-approved database who consecutively underwent radical prostatectomy between 2002 and 2007. Patients were stratified by type of anaesthesia, administered as general anaesthesia alone, or spinal anaesthesia in addition to general anaesthesia. Biochemical recurrence-free survival, metastasis-free survival and overall survival were analysed by a multivariate Cox regression model and by Kaplan-Meier analysis in propensity-score based matched cohorts, adjusted for standard clinico-pathological variables and year of surgery. RESULTS Overall, 4772 patients were analysed. Regarding the type of anaesthesia no significant difference for biochemical recurrence-free survival, metastasis-free survival and overall survival was analysed by a multivariate Cox regression model (p = 0.5, 0.8 and 0.7). The Kaplan-Meier analyses after propensity-score matched based comparisons revealed no significant difference depending on type of anaesthesia for biochemical recurrence-free survival, metastasis-free survival and overall survival (p = 0.6, 0.1 and 0.4). The same accounted for a propensity-score matched model adjusted for the year of surgery on biochemical recurrence-free survival (p = 0.7). CONCLUSIONS The oncological outcome after radical prostatectomy was not affected by the adjunctive use of spinal anaesthesia.
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Affiliation(s)
- M Roiss
- Department of Anaesthesiology, Center of Anaesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Germany
| | - J Schiffmann
- Martini-Clinic, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Germany
| | - P Tennstedt
- Martini-Clinic, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Germany
| | - T Kessler
- Department of Anaesthesiology, Center of Anaesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Germany
| | - I Blanc
- Department of Anaesthesiology, Center of Anaesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Germany
| | - A Goetz
- Department of Anaesthesiology, Center of Anaesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Germany
| | - T Schlomm
- Martini-Clinic, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Germany; Department of Urology, Section for Translational Prostate Cancer Research, University Medical Center Hamburg-Eppendorf, Germany
| | - M Graefen
- Martini-Clinic, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Germany
| | - D A Reuter
- Department of Anaesthesiology, Center of Anaesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Germany.
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Gandaglia G, Becker A, Trinh QD, Abdollah F, Schiffmann J, Roghmann F, Tian Z, Montorsi F, Briganti A, Karakiewicz P, Sun M. Long-term survival in patients with germ cell testicular cancer: A population-based competing-risks regression analysis. Eur J Surg Oncol 2014; 40:103-12. [DOI: 10.1016/j.ejso.2013.09.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 08/30/2013] [Accepted: 09/12/2013] [Indexed: 12/19/2022] Open
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Wintsch K, Helaly P, Meuli C, Schiffmann J. [10 years results following augmentation-plasty]. Helv Chir Acta 1989; 55:879-86. [PMID: 2753727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
In order to investigate late results in cases with mamma-augmentations, we have controlled cases which have been operated between 1970 and 1980. From a total number of 70 cases 34 have appeared for control. In spite of the problems of capsular contracture the interest for mamma-augmentation has rather increased during this period of time. We have mainly used 3 types of implants: 1. gelfilled silicon prosthesis, 2. inflatable prosthesis, 3. gelfilled prosthesis with polyurethan coating (Aeshly). In most of the inflatable prosthesis (5) spontaneous perforations occurred so that they had to be exchanged. In 41 cases a simple augmentation was performed. Out of these 16 have been controlled. In 4 cases an augmentation was combined with mastopexy. All of these appeared for control. 13 out of 17 cases of subcutaneous mastectomy with augmentation mammaplasty were controlled. In all cases of subcutaneous mastectomy the prosthesis were placed retropectoral. In 18 cases the prostheses were exchanged either because of leakage or when the prosthesis was injured during a capsulotomy. In 2 cases the prosthesis was removed, in 1 case because of problems with the skin and in another case because of repeated severe capsular contracture even after two capsulotomies. The classification of Baker was used to express the severity of capsular contracture. Prosthesis which was placed retropectorally showed significantly less problems with capsular contracture than prosthesis which was placed subglandular.(ABSTRACT TRUNCATED AT 250 WORDS)
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Schiffmann J. Mastitis typhosa suppurativa bilateralis. Dtsch Med Wochenschr 1927. [DOI: 10.1055/s-0028-1126856] [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: 10/20/2022]
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Schiffmann J. Ein Drüsenpolyp vom Bau der Dickdarmschleimhaut in der fossa navicularis eines zwölfjährigen Mädchens. Arch Gynecol Obstet 1927. [DOI: 10.1007/bf01745018] [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: 10/25/2022]
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