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Agarwal DK, Mulholland C, Koye DN, Sathianathen N, Yao H, Dundee P, Moon D, Furrer M, Giudice C, Wang W, Simpson JA, Kearsley J, Norris B, Zargar H, Pan HY, Mottrie A, Fuller A, Mottaran A, Challacombe B, Kua B, Metcalfe C, Wagner C, Dubey D, Gomez Sancha F, Bruyère F, Gautam G, Pooleri GK, Bozzini G, Lau H, Thyer I, Teoh J, Vass J, Vivian J, McDermott K, Winter M, Ragavan N, Campbell N, Harke NN, Richard PO, Teloken P, Dekuyper P, Sutherland P, Ahlawat R, Nair R, Pemberton R, Catterwell R, Oomen RJ, Weston R, Moritz R, Krishnappa RS, Leslie S, Van Appledorn S, Yuvaraja T, Meert T, Dujardin T, Gross T, Walton T, Huang WC, Caumartin Y, Agarwal A, Lawrentschuk N, Corcoran NM. Corrigendum to "RPN (Radius, Position of tumour, iNvasion of renal sinus) Classification and Nephrometry Scoring System: An Internationally Developed Clinical Classification To Describe the Surgical Difficulty for Renal Masses for Which Robotic Partial Nephrectomy Is Planned" [Eur. Urol. Open Sci. 54 (2023) 33-42]. EUR UROL SUPPL 2024; 63:2-3. [PMID: 38523653 PMCID: PMC10958212 DOI: 10.1016/j.euros.2024.03.001] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Abstract
[This corrects the article DOI: 10.1016/j.euros.2023.05.007.].
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Affiliation(s)
- Dinesh K. Agarwal
- Department of Urology, The Royal Melbourne Hospital, Melbourne, Australia
- Department of Urology, Western Health, Melbourne, Australia
- Department of Urology, Mercy Health, Melbourne, Australia
| | - Clancy Mulholland
- Department of Urology, The Royal Melbourne Hospital, Melbourne, Australia
| | - Digsu N. Koye
- Centre for Epidemiology and Biostatics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | - Henry Yao
- Department of Urology, Western Health, Melbourne, Australia
| | - Philip Dundee
- Department of Urology, The Royal Melbourne Hospital, Melbourne, Australia
| | - Daniel Moon
- University of Melbourne, Royal Melbourne Clinical School, Melbourne, Australia
| | - Marc Furrer
- Department of Urology, The Royal Melbourne Hospital, Melbourne, Australia
- Urology Centre, Guy’s and St. Thomas’ Hospitals NHS Trust, London, UK
- Department of Urology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Christina Giudice
- Department of Radiology, The Royal Melbourne Hospital, Melbourne, Australia
| | - Wayland Wang
- Department of Radiology, The Royal Melbourne Hospital, Melbourne, Australia
| | - Julie A. Simpson
- Centre for Epidemiology and Biostatics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Jamie Kearsley
- Department of Urology, The Royal Melbourne Hospital, Melbourne, Australia
| | - Briony Norris
- Department of Urology, The Royal Melbourne Hospital, Melbourne, Australia
| | - Homi Zargar
- Department of Urology, The Royal Melbourne Hospital, Melbourne, Australia
| | - Henry Y.C. Pan
- Department of Urology, The Royal Melbourne Hospital, Melbourne, Australia
| | - Alex Mottrie
- Department of Urology, OLV Hospital, Aalst, Belgium
- Orsi Academy, Ghent, Belgium
| | - Andrew Fuller
- Department of Urology, Royal Adelaide Hospital, Adelaide, Australia
| | - Angelo Mottaran
- Department of Urology, OLV Hospital, Aalst, Belgium
- Orsi Academy, Ghent, Belgium
| | - Ben Challacombe
- Urology Centre, Guy’s and St. Thomas’ Hospitals NHS Trust, London, UK
| | - Boon Kua
- Department of Urology, Wesley Hospital, Brisbane, Australia
| | - Charles Metcalfe
- Division of Urology, Department of Surgery, University of Calgary, Calgary, Canada
| | | | - Deepak Dubey
- Department of Urology, Manipal Hospital, Bangalore, India
| | | | | | - Gagan Gautam
- Division of Urologic Oncology, Max Institute of Cancer Care, New Delhi, India
| | - Ginil K. Pooleri
- Division of Uro-oncology, Department of Urology, Amrita Institute of Medical Sciences, Kochi, India
| | | | - Howard Lau
- Department of Urology, Westmead Hospital, Sydney, Australia
| | - Isaac Thyer
- Department of Urology, Fiona Stanley Hospital, Perth, Australia
| | - Jeremy Teoh
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Justin Vass
- Department of Urology, Royal North Shore Hospital, Sydney, Australia
| | - Justin Vivian
- Department of Urology, St. John of God Subiaco Hospital, Perth, Australia
| | - Kara McDermott
- Department of Urology, Sir Charles Gairdner Hospital, Perth, Australia
| | - Mathew Winter
- Department of Urology, Royal North Shore Hospital, Sydney, Australia
| | | | | | - Nina N. Harke
- Department of Urology, Hannover Medical School, Hannover, Germany
| | - Patrick O. Richard
- Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Sherbrooke, University of Sherbrooke, Sherbrooke, Canada
| | - Patrick Teloken
- Department of Urology, Sir Charles Gairdner Hospital, Perth, Australia
| | - Peter Dekuyper
- Department of Urology, AZ Maria Middelares, Ghent, Belgium
| | | | - Rajesh Ahlawat
- Division of Urology and Renal Transplantation, Medanta Kidney and Urology Institute, Gurgaon, India
| | - Rajesh Nair
- Urology Centre, Guy’s and St. Thomas’ Hospitals NHS Trust, London, UK
| | - Richard Pemberton
- Department of Urology, St. John of God Subiaco Hospital, Perth, Australia
| | - Rick Catterwell
- Urology Centre, Guy’s and St. Thomas’ Hospitals NHS Trust, London, UK
- Department of Urology, Royal Adelaide Hospital, Adelaide, Australia
| | - Robert J.A. Oomen
- Department of Urology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Robin Weston
- Department of Urology, Royal Liverpool University Hospital, Liverpool, UK
| | - Rudolf Moritz
- Department of Urology and Neuro-Urology, Marien Hospital, Herne, Germany
| | | | - Scott Leslie
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | | | - T.B. Yuvaraja
- Department of Uro-Oncology, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India
| | - Thibault Meert
- Department of Urology, Imelda Hospital, Bonheiden, Belgium
| | - Thierry Dujardin
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec, Canada
| | - Tobias Gross
- Urology Unit, Die Berner Urologen AG, Bern, Switzerland
| | - Tom Walton
- Department of Urology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - William C. Huang
- Departments of Urology and Radiology, NYU Langone Health, New York, NY, USA
| | - Yves Caumartin
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec, Canada
| | - Ashwin Agarwal
- St. Vincent’s Clinical School, University of Melbourne, Melbourne, Australia
| | - Nathan Lawrentschuk
- Department of Urology, The Royal Melbourne Hospital, Melbourne, Australia
- University of Melbourne, Royal Melbourne Clinical School, Melbourne, Australia
- Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - Niall M. Corcoran
- Department of Urology, The Royal Melbourne Hospital, Melbourne, Australia
- Department of Urology, Western Health, Melbourne, Australia
- University of Melbourne, Royal Melbourne Clinical School, Melbourne, Australia
- Victorian Comprehensive Cancer Centre, Melbourne, Australia
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von Deimling M, Mertens LS, Furrer M, Li R, Tendijck GAH, Taylor J, Crocetto F, Maas M, Mari A, Pichler R, Moschini M, Tully KH, D'Andrea D, Laukhtina E, Del Giudice F, Marcq G, Velev M, Gallioli A, Albisinni S, Mori K, Khanna A, Rink M, Fisch M, Minervini A, Black PC, Lotan Y, Spiess PE, Kiss B, Shariat SF, Pradere B. The optimal number of induction chemotherapy cycles in clinically lymph node-positive bladder cancer. BJU Int 2024. [PMID: 38470089 DOI: 10.1111/bju.16319] [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: 03/13/2024]
Abstract
OBJECTIVE To investigate the optimal number of induction chemotherapy cycles needed to achieve a pathological response in patients with clinically lymph node-positive (cN+) bladder cancer (BCa) who received three or four cycles of induction chemotherapy followed by consolidative radical cystectomy (RC) with pelvic lymph node dissection. PATIENTS AND METHODS We included 388 patients who received three or four cycles of cisplatin/gemcitabine or (dose-dense) methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC), followed by consolidative RC for cTanyN1-3M0 BCa. We compared pathological complete (pCR = ypT0N0) and objective response (pOR = yp ≤T1N0) between treatment groups. Predictors of pCR and/or pOR were assessed using uni- and multivariable logistic regression analysis. The secondary endpoints were overall (OS) and cancer-specific survival (CSS). We evaluated the association between the number of induction chemotherapy cycles administered and survival outcomes on multivariable Cox regression. RESULTS Overall, 101 and 287 patients received three or four cycles of induction chemotherapy, respectively. Of these, 72 (19%) and 128 (33%) achieved pCR and pOR response, respectively. The pCR (20%, 18%) and pOR (40%, 31%) rates did not differ significantly between patients receiving three or four cycles (P > 0.05). The number of cycles was not associated with pCR or pOR on multivariable logistic regression analyses. The 2-year OS estimates were 63% (95% confidence interval [CI] 0.53-0.74) and 63% (95% CI 0.58-0.7) for patients receiving three or four cycles, respectively. Receiving three vs four cycles was not associated with OS and CSS on uni- or multivariable Cox regression analyses. CONCLUSION Pathological response and survival outcomes did not differ between administering three or four induction chemotherapy cycles in patients with cN+ BCa. A fewer cycles (minimum three) may be oncologically sufficient in patients with cN+ BCa, while decreasing the wait for definitive local therapy in those patients who end up without a response to chemotherapy. This warrants further validation.
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Affiliation(s)
- Markus von Deimling
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Laura S Mertens
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marc Furrer
- Department of Urology, University Hospital of Bern, University of Bern, Bern, Switzerland
- Department of Urology, Solothurner Spitäler AG, Kantonsspital Olten and Bürgerspital Solothurn, Switzerland
| | - Roger Li
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Guus A H Tendijck
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jacob Taylor
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
| | - Felice Crocetto
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Moritz Maas
- Department of Urology, Eberhard Karls University Tübingen, Tübingen, Germany
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Andrea Mari
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Renate Pichler
- Department of Urology, Comprehensive Cancer Center Innsbruck, Medical University of Innsbruck, Innsbruck, Austria
| | - Marco Moschini
- Department of Urology, Urological Research Institute, Vita-Salute San Raffaele, Milan, Italy
| | - Karl H Tully
- Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - David D'Andrea
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Ekaterina Laukhtina
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Francesco Del Giudice
- Department of Maternal Infant and Urologic Sciences, Policlinico Umberto I Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Gautier Marcq
- Department of Urology, CHU Lille, Claude Huriez Hospital, Lille, France
- CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, UMR9020-U1277 - CANTHER - Cancer Heterogeneity Plasticity and Resistance to Therapies, University of Lille, Lille, France
| | - Maud Velev
- Department of Cancer Medicine, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Andrea Gallioli
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Simone Albisinni
- Urology Unit, Department of Surgical Sciences, Tor Vergata University Hospital, University of Rome Tor Vergata, Rome, Italy
- Service d'Urologie, Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Keiichiro Mori
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | | | - Michael Rink
- Department of Urology, Marienkrankenhaus, Hamburg, Germany
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andrea Minervini
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Peter C Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
| | - Philippe E Spiess
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Bernhard Kiss
- Department of Urology, University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
- Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, Urosud, La Croix Du Sud Hospital, Quint-Fonsegrives, France
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von Deimling M, Furrer M, Mertens LS, Mari A, van Ginkel N, Bacchiani M, Maas M, Pichler R, Li R, Moschini M, Bianchi A, Vetterlein MW, Lonati C, Crocetto F, Taylor J, Tully KH, Afferi L, Soria F, Del Giudice F, Longoni M, Laukhtina E, Antonelli A, Rink M, Fisch M, Lotan Y, Spiess PE, Black PC, Kiss B, Pradere B, Shariat SF. Impact of the extent of lymph node dissection on survival outcomes in clinically lymph node-positive bladder cancer. BJU Int 2024; 133:341-350. [PMID: 37904652 DOI: 10.1111/bju.16210] [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: 11/01/2023]
Abstract
OBJECTIVE To determine the oncological impact of extended pelvic lymph node dissection (ePLND) vs standard PLND (sPLND) during radical cystectomy (RC) in clinically lymph node-positive (cN+) bladder cancer (BCa). PATIENTS AND METHODS In this retrospective, multicentre study we included 969 patients who underwent RC with sPLND (internal/external iliac and obturator lymph nodes) or ePLND (sPLND plus common iliac and presacral nodes) with or without platin-based peri-operative chemotherapy for cTany N1-3 M0 BCa between 1991 and 2022. We assessed the impact of ePLND on recurrence-free survival (RFS) and the distribution of recurrences (locoregional and distant recurrences). The secondary endpoint was overall survival (OS). We performed propensity-score matching using covariates associated with the extent of PLND in univariable logistic regression analysis. The association of the extent of PLND with RFS and OS was investigated using Cox regression models. RESULTS Of 969 cN+ patients, 510 were 1:1 matched on propensity scores. The median (interquartile range [IQR]) time to recurrence was 8 (4-16) months, and median (IQR) follow-up of alive patients was 30 (13-51) months. Disease recurrence was observed in 104 patients in the ePLND and 107 in the sPLND group. Of these, 136 (27%), 47 (9.2%) and 19 patients (3.7%) experienced distant, locoregional, or both distant and locoregional disease recurrence, respectively. When stratified by the extent of PLND, we did not find a difference in recurrence patterns (P > 0.05). ePLND improved neither RFS (hazard ratio [HR] 0.91, 95% confidence interval [CI] 0.70-1.19; P = 0.5) nor OS (HR 0.78, 95% CI 0.60-1.01; P = 0.06) compared to sPLND. Stratification by induction chemotherapy did not change outcomes. CONCLUSION Performing an ePLND at the time of RC in cN+ patients improved neither RFS nor OS compared to sPLND, regardless of induction chemotherapy status. Pretreatment risk stratification is paramount to identify ideal candidates for RC with ePLND as part of a multimodal treatment approach.
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Affiliation(s)
- Markus von Deimling
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marc Furrer
- Department of Urology, University Hospital of Bern, University of Bern, Bern, Switzerland
- Department of Urology, Solothurner Spitäler AG, Olten, Solothurn, Switzerland
| | - Laura S Mertens
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Andrea Mari
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Noor van Ginkel
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Mara Bacchiani
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Moritz Maas
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
- Department of Urology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Renate Pichler
- Department of Urology, Comprehensive Cancer Center Innsbruck, Medical University of Innsbruck, Innsbruck, Austria
| | - Roger Li
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Marco Moschini
- Department of Urology, Urological Research Institute, Milan, Italy
| | - Alberto Bianchi
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Malte W Vetterlein
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Chiara Lonati
- Department of Urology, Spedali Civili of Brescia, Brescia, Italy
| | - Felice Crocetto
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples 'Federico II', Naples, Italy
| | - Jacob Taylor
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
| | - Karl H Tully
- Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Luca Afferi
- Department of Urology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Francesco Soria
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy
| | - Francesco Del Giudice
- Department of Maternal Infant and Urologic Sciences, 'Sapienza' University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Mattia Longoni
- Department of Urology, Urological Research Institute, Milan, Italy
| | - Ekaterina Laukhtina
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Alessandro Antonelli
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Michael Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
| | - Philippe E Spiess
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Peter C Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Bernhard Kiss
- Department of Urology, University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, Urosud, La Croix Du Sud Hospital, Quint-Fonsegrives, France
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
- Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
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Agarwal DK, Mulholland C, Koye DN, Sathianathen N, Yao H, Dundee P, Moon D, Furrer M, Giudice C, Wang W, Simpson JA, Kearsley J, Norris B, Zargar H, Pan HY, Agarwal A, Lawrentschuk N, Corcoran NM. RPN (Radius, Position of tumour, iNvasion of renal sinus) Classification and Nephrometry Scoring System: An Internationally Developed Clinical Classification To Describe the Surgical Difficulty for Renal Masses for Which Robotic Partial Nephrectomy Is Planned. EUR UROL SUPPL 2023; 54:33-42. [PMID: 37545848 PMCID: PMC10397239 DOI: 10.1016/j.euros.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 08/08/2023] Open
Abstract
Background The surgical difficulty of partial nephrectomy (PN) varies depending on the operative approach. Existing nephrometry classifications for assessment of surgical difficulty are not specific to the robotic approach. Objective To develop an international robotic-specific classification of renal masses for preoperative assessment of surgical difficulty of robotic PN. Design setting and participants The RPN classification (Radius, Position of tumour, iNvasion of renal sinus) considers three parameters: tumour size, tumour position, and invasion of the renal sinus. In an international survey, 45 experienced robotic surgeons independently reviewed de-identified computed tomography images of 144 patients with renal tumours to assess surgical difficulty of robot-assisted PN using a 10-point Likert scale. A separate data set of 248 patients was used for external validation. Outcome measurements and statistical analysis Multiple linear regression was conducted and a risk score was developed after rounding the regression coefficients. The RPN classification was correlated with the surgical difficulty score derived from the international survey. External validation was performed using a retrospective cohort of 248 patients. RPN classification was also compared with the RENAL (Radius; Exophytic/endophytic; Nearness; Anterior/posterior; Location), PADUA (Preoperative Aspects and Dimensions Used for Anatomic), and SPARE (Simplified PADUA REnal) scoring systems. Results and limitation The median tumour size was 38 mm (interquartile range 27-49). The majority (81%) of renal tumours were peripheral, followed by hilar (12%) and central (7.6%) locations. Noninvasive and semi-invasive tumours accounted for 37% each, and 26% of the tumours were invasive. The mean surgical difficulty score was 5.2 (standard deviation 1.9). Linear regression analysis indicated that the RPN classification correlated very well with the surgical difficulty score (R2 = 0.80). The R2 values for the other scoring systems were: 0.66 for RENAL, 0.75 for PADUA, and 0.70 for SPARE. In an external validation cohort, the performance of all four classification systems in predicting perioperative outcomes was similar, with low R2 values. Conclusions The proposed RPN classification is the first nephrometry system to assess the surgical difficulty of renal masses for which robot-assisted PN is planned, and is a useful tool to assist in surgical planning, training and data reporting. Patient summary We describe a simple classification system to help urologists in preoperative assessment of the difficulty of robotic surgery for partial kidney removal for kidney tumours.
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Affiliation(s)
- Dinesh K. Agarwal
- Department of Urology, The Royal Melbourne Hospital, Melbourne, Australia
- Department of Urology, Western Health, Melbourne, Australia
- Department of Urology, Mercy Health, Melbourne, Australia
| | - Clancy Mulholland
- Department of Urology, The Royal Melbourne Hospital, Melbourne, Australia
| | - Digsu N. Koye
- Centre for Epidemiology and Biostatics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | - Henry Yao
- Department of Urology, Western Health, Melbourne, Australia
| | - Philip Dundee
- Department of Urology, The Royal Melbourne Hospital, Melbourne, Australia
| | - Daniel Moon
- University of Melbourne, Royal Melbourne Clinical School, Melbourne, Australia
| | - Marc Furrer
- Department of Urology, The Royal Melbourne Hospital, Melbourne, Australia
- Urology Centre, Guy’s and St. Thomas’ Hospitals NHS Trust, London, UK
- Urology Unit, Die Berner Urologen AG, Bern, Switzerland
| | - Christina Giudice
- Department of Radiology, The Royal Melbourne Hospital, Melbourne, Australia
| | - Wayland Wang
- Department of Radiology, The Royal Melbourne Hospital, Melbourne, Australia
| | - Julie A. Simpson
- Centre for Epidemiology and Biostatics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Jamie Kearsley
- Department of Urology, The Royal Melbourne Hospital, Melbourne, Australia
| | - Briony Norris
- Department of Urology, The Royal Melbourne Hospital, Melbourne, Australia
| | - Homi Zargar
- Department of Urology, The Royal Melbourne Hospital, Melbourne, Australia
| | - Henry Y.C. Pan
- Department of Urology, The Royal Melbourne Hospital, Melbourne, Australia
| | - Ashwin Agarwal
- St. Vincent’s Clinical School, University of Melbourne, Melbourne, Australia
| | - Nathan Lawrentschuk
- Department of Urology, The Royal Melbourne Hospital, Melbourne, Australia
- University of Melbourne, Royal Melbourne Clinical School, Melbourne, Australia
- Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - Niall M. Corcoran
- Department of Urology, The Royal Melbourne Hospital, Melbourne, Australia
- Department of Urology, Western Health, Melbourne, Australia
- University of Melbourne, Royal Melbourne Clinical School, Melbourne, Australia
- Victorian Comprehensive Cancer Centre, Melbourne, Australia
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5
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Sholklapper TN, Ballon J, Sayegh AS, La Riva A, Perez LC, Huang S, Eppler M, Nelson G, Marchegiani G, Hinchliffe R, Gordini L, Furrer M, Brenner MJ, Dell-Kuster S, Biyani CS, Francis N, Kaafarani HM, Siepe M, Winter D, Sosa JA, Bandello F, Siemens R, Walz J, Briganti A, Gratzke C, Abreu AL, Desai MM, Sotelo R, Agha R, Lillemoe KD, Wexner S, Collins GS, Gill I, Cacciamani GE. Bibliometric analysis of academic journal recommendations and requirements for surgical and anesthesiologic adverse events reporting. Int J Surg 2023; 109:1489-1496. [PMID: 37132189 PMCID: PMC10389352 DOI: 10.1097/js9.0000000000000323] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 01/31/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND Standards for reporting surgical adverse events (AEs) vary widely within the scientific literature. Failure to adequately capture AEs hinders efforts to measure the safety of healthcare delivery and improve the quality of care. The aim of the present study is to assess the prevalence and typology of perioperative AE reporting guidelines among surgery and anesthesiology journals. MATERIALS AND METHODS In November 2021, three independent reviewers queried journal lists from the SCImago Journal & Country Rank (SJR) portal (www.scimagojr.com), a bibliometric indicator database for surgery and anesthesiology academic journals. Journal characteristics were summarized using SCImago, a bibliometric indicator database extracted from Scopus journal data. Quartile 1 (Q1) was considered the top quartile and Q4 bottom quartile based on the journal impact factor. Journal author guidelines were collected to determine whether AE reporting recommendations were included and, if so, the preferred reporting procedures. RESULTS Of 1409 journals queried, 655 (46.5%) recommended surgical AE reporting. Journals most likely to recommend AE reporting were: by category surgery (59.1%), urology (53.3%), and anesthesia (52.3%); in top SJR quartiles (i.e. more influential); by region, based in Western Europe (49.8%), North America (49.3%), and the Middle East (48.3%). CONCLUSIONS Surgery and anesthesiology journals do not consistently require or provide recommendations on perioperative AE reporting. Journal guidelines regarding AE reporting should be standardized and are needed to improve the quality of surgical AE reporting with the ultimate goal of improving patient morbidity and mortality.
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Affiliation(s)
- Tamir N. Sholklapper
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, Los Angeles, California
- Department of Urology, Einstein Healthcare Network, Philadelphia, Pennsylvania
| | - Jorge Ballon
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, Los Angeles, California
| | - Aref S. Sayegh
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, Los Angeles, California
| | - Anibal La Riva
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, Los Angeles, California
- Department of General Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Laura C. Perez
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, Los Angeles, California
- Department of Surgery, Johns Hopkins Medicine, Baltimore, Maryland
| | - Sherry Huang
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, Los Angeles, California
| | - Michael Eppler
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, Los Angeles, California
| | - Gregg Nelson
- Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | | | | | - Luca Gordini
- Division of Endocrine Surgery, “Agostino Gemelli” School of Medicine, University Foundation Polyclinic, Catholic University of the Sacred Heart, Rome
| | - Marc Furrer
- Department of Urology, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, London
- Department of Urology, University of Bern, Inselspital, Bern
| | - Michael J. Brenner
- Department of Otolaryngology-Head & Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Salome Dell-Kuster
- Clinic for Anaesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy; University Hospital Basel, Switzerland
| | | | - Nader Francis
- Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Yeovil
| | | | - Matthias Siepe
- Department of Cardiac Surgery, Cardiovascular Center, Inselspital, Bern
| | - Des Winter
- Center for Colorectal Disease, St Vincent’s University Hospital, Dublin, Ireland
| | - Julie A. Sosa
- Department of Surgery, University of California San Francisco (UCSF), San Francisco, California
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Robert Siemens
- Department of Urology, Queen’s University, Kingston, Ontario, Canada
| | - Jochen Walz
- Department of Urology, Intitut Paoli-Calmettes Cancer Centre, Marseille, France
| | - Alberto Briganti
- Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele
- University Vita-Salute San Raffaele, Milan
| | - Christian Gratzke
- Department of Urology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Andre L. Abreu
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, Los Angeles, California
| | - Mihir M. Desai
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, Los Angeles, California
| | - Rene Sotelo
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, Los Angeles, California
| | | | - Keith D. Lillemoe
- Department of Surgery, Massachusetts General Hospital and the Harvard Medical School, Boston, MA, USA
| | - Steven Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA
| | - Gary S. Collins
- UK EQUATOR Centre, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, & Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Inderbir Gill
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, Los Angeles, California
| | - Giovanni E. Cacciamani
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, Los Angeles, California
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O'Brien JS, Teh J, Kelly BD, Chen K, Manning T, Furrer M, Chee J, Lawrentschuk N. Interrogating the Impassable: A Case Series and Literature Review of Unilateral SPECT-CT Groin Visualization in Men With Penile Cancer. Front Surg 2022; 9:882011. [PMID: 35662824 PMCID: PMC9157642 DOI: 10.3389/fsurg.2022.882011] [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: 02/23/2022] [Accepted: 03/30/2022] [Indexed: 12/24/2022] Open
Abstract
Penile squamous cell carcinoma (SCC) is a rare malignancy, which is known to invade local inguinal lymph nodes prior to progressing to the pelvis. Dynamic sentinel lymph node biopsy (DSLNB) is a standard for the minimally invasive assessment of lymphadenopathy in patients with subclinical groin metastasis. Hybrid 99mTc Single-Photon Emission Computed Tomography (SPECT-CT) has been shown to increase the accuracy of identifying first draining “sentinel” nodes (SN). Unilateral inguinal visualization on SPECT-CT is a rare presentation, which may increase the likelihood of a false negative SN biopsy. Retrospective analysis from three-penile cancer uro-oncologists in Melbourne, Australia identified 78 groins undergoing DSLNB for intermediate/high risk primary disease. Unilateral SPECT-CT results were observed in four patients suggesting a functional pattern of lymph diversion. Analysis confirmed malignancy (n = 2), sarcoidosis (n = 1), and evidence of local inflammation in SPECT-CT negative groins. Findings re-iterate the role of SPECT-CT a pre-operative adjunct. Experienced multimodal groin assessment using palpation, SPECT-CT, lymphoscintigraphy, and blue dye tracking remains paramount. Unilateral SN on pre-operative SPECT-CT in men with intermediate/high-risk penile SCC should elicit a higher degree of clinical suspicion. We recommend a low threshold for recommending radical inguinal lymph node dissection (ILND) for groins refractory to minimally invasive assessment.
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Affiliation(s)
- Jonathan S. O'Brien
- Division of Cancer Surgery, Peter MacCallum Cancer Center, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
- Department of Urology, The Royal Melbourne Hospital, Melbourne, VIC, Australia
- Young Urology Researchers Organization (YURO), Melbourne, VIC, Australia
| | - Jiasian Teh
- Division of Cancer Surgery, Peter MacCallum Cancer Center, Melbourne, VIC, Australia
- Young Urology Researchers Organization (YURO), Melbourne, VIC, Australia
| | - Brian D. Kelly
- Division of Cancer Surgery, Peter MacCallum Cancer Center, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Kenneth Chen
- Division of Cancer Surgery, Peter MacCallum Cancer Center, Melbourne, VIC, Australia
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Todd Manning
- Young Urology Researchers Organization (YURO), Melbourne, VIC, Australia
- Department of Surgery, Austin Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Marc Furrer
- Department of Urology, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Justin Chee
- MURAC Health, East Melbourne, VIC, Australia
| | - Nathan Lawrentschuk
- Division of Cancer Surgery, Peter MacCallum Cancer Center, Melbourne, VIC, Australia
- Department of Urology, The Royal Melbourne Hospital, Melbourne, VIC, Australia
- EJ Whitten Prostate Cancer Research Center at Epworth Healthcare, Melbourne, VIC, Australia
- *Correspondence: Nathan Lawrentschuk
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Sathianathen N, Furrer M, Murphy D, Weight C, Gupta S, Lawrentschuk N. MP12-19 ADJUVANT SYSTEMIC TREATMENT FOR RENAL CANCER AFTER SURGERY: A NETWORK META-ANALYSIS. J Urol 2022. [DOI: 10.1097/ju.0000000000002534.19] [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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8
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Furrer K, Weder W, Eboulet E, Betticher D, Pless M, Stupp R, Krueger T, Perentes J, Schmid R, Lardinois D, Furrer M, Fruh M, Peters S, Curioni-Fontecedro A, Stahel R, Rothschild S, Hayoz S, Thierstein S, Biaggi C, Opitz I. P30.01 Extended Resections for Advanced Stages T3/T4 NSCLC After Neoadjuvant Treatment: Conclusions of SAKK Pooled Analysis (16/96, 16/00, 16/01). J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.404] [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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9
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Bumm R, Lasso A, Kawel-Böhm N, Wäckerlin A, Ludwig P, Furrer M. First results of spatial reconstruction and quantification of COVID-19 chest CT infiltrates using lung CT analyzer and 3D slicer. Br J Surg 2021. [PMCID: PMC8194685 DOI: 10.1093/bjs/znab202.077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective Lung CT scans are early diagnostic tests in evaluation of COVID-19 patients. Data are usually analyzed visually and the extent of infiltrations can only roughly be estimated. The aim of the present study was to create a software to spatially visualize and quantify infiltrated and collapsed areas in lung CT scans and set these volumes into relation with non-affected lung areas. Methods A new software "Lung CT Analyzer" (LCTA, 1) was created from scratch in an international team-effort within the 3D medical imaging software 3D Slicer (2). LCTA consists of two components: "Lung CT Segmenter" implements an intuitive and semiautomatic workflow for the generation of lung masks. LCTA then uses masked thresholds of Hounsfield units to detect non-affected versus affected (emphysematous, infiltrated, and collapsed) areas of the lung. Intrapulmonary vessels are subtracted from the other volumes. Segment volumes are expressed in milliliters and displayed in 3D. COVID-Q was defined as affected divided by non-affected volume and can be calculated separately for both lungs. 3D Slicer and LCTA are open source, freely available and maintained on Github. Results CT data of twelve patients with moderate to severe COVID-19 (9 m, 3 f) were selected for the present retrospective study. All scans were performed shortly after admission. Thresholds of Hounsfield units (HU) for areas of interest were defined prior to the study and processing was identical for all patients. The median time effort for 3D reconstruction was 8 minutes per patient. For more detailed results please see the enclosed table. A 3D Slicer demo data set (Control) has been included for comparison. Conclusion The COVID-19 pandemic promoted fast-paced innovations such as LCTA in our hospital. LCTA was feasible, reproducible and easy to perform. COVID-Q correlated with COVID-19 lung involvement in all cases. All fatal cases showed COVID-Q values of > 2.0. LCTA enabled the serial 3D reconstruction of infiltrated and collapsed lung areas in lung CT scans. The procedure may be of great help in the future analysis of pulmonary infiltrates of any cause. In COVID-19 disease, volumetric lung CT reconstruction could result in the definition of new prognostic factors, identify patients “at-risk” in the ICU, and be useful for follow-up. (1) Lung CT Analyzer: https://github.com/rbumm/SlicerLungCTAnalyzer (2) 3D Slicer: http://slicer.org
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Affiliation(s)
- R Bumm
- Department of Surgery, Cantonal Hospital Graubünden, Chur, Switzerland
| | - A Lasso
- Laboratory for Percutaneous Surgery, The Perk Lab, Kingston, Jamaica
| | - N Kawel-Böhm
- Department of Radiology, Cantonal Hospital Graubünden, Chur, Switzerland
| | - A Wäckerlin
- Department of Intensive Care, Cantonal Hospital Graubünden, Chur, Switzerland
| | - P Ludwig
- Department of Pneumonology, Cantonal Hospital Graubünden, Chur, Switzerland
| | - M Furrer
- Department of Surgery, Cantonal Hospital Graubünden, Chur, Switzerland
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10
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Silagy AW, Young R, Kelly BD, Reeves F, Furrer M, Costello AJ, Challacombe BJ, Corcoran NM, Kearsley J, Dundee P, Agarwal DK. Surgical innovation revisited: A historical narrative of the minimally invasive “Agarwal sliding‐clip renorrhaphy” technique for partial nephrectomy and its application to an Australian cohort. BJUI Compass 2021; 2:211-218. [PMID: 35475136 PMCID: PMC8988750 DOI: 10.1002/bco2.78] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/14/2021] [Accepted: 02/14/2021] [Indexed: 01/20/2023] Open
Abstract
Objective To evaluate local clinical outcomes of sliding clip renorrhaphy, from inception to current utilization for open, laparoscopic, and robotically assisted partial nephrectomy. Methods We reviewed prospectively maintained databases of three surgeons performing partial nephrectomies with the sliding‐clip technique at teaching hospitals between 2005 and 2019. Baseline characteristics, operative parameters, including surgical approach, RENAL Nephrometry Score, and post‐operative outcomes, including Clavien‐Dindo classification of complications, were recorded for 76 consecutive cases. We compared perioperative and 90‐day events with patient and tumor characteristics, stratified by operative approach and case complexity, using Wilcoxon rank‐sum test for continuous variables and the Chi‐squared or Fisher's exact test, for binary and categorical variables, respectively. Results Open surgery (n = 15) reduced ischemia time and operative time, but increased hospital admission time. Pre‐ and post‐operative estimated glomerular filtration rates did not change significantly by operative approach. Older patients (P = .007) and open surgery (P = .003) were associated with a higher rate of complications (any‐grade). Six grade ≥3 complications occurred: these were associated with higher RENAL Nephrometry Score (P = .016) and higher pathological tumor stage (P = .045). Limits include smaller case volumes which incorporate the learning curve cases; therefore, these data are most applicable to lower volume teaching hospitals. Conclusion The sliding‐clip technique for partial nephrectomy was first described by Agarwal et al and has low complication rates, acceptable operative time, and preserves renal function across open and minimally invasive surgeries. This series encompasses the initial learning curve with developing the technique through to present‐day emergence as a routine standard of practice.
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Affiliation(s)
- A. W. Silagy
- Department of Urology Royal Melbourne Hospital Melbourne VIC Australia
| | - R. Young
- Department of Urology Royal Melbourne Hospital Melbourne VIC Australia
| | - B. D. Kelly
- Department of Urology Royal Melbourne Hospital Melbourne VIC Australia
| | - F. Reeves
- Department of Urology Austin Health Melbourne VIC Australia
| | - M. Furrer
- Department of Urology Royal Melbourne Hospital Melbourne VIC Australia
- Department of Urology Inselspital, Bern University Hospital Bern Switzerland
| | - A. J. Costello
- Department of Urology Royal Melbourne Hospital Melbourne VIC Australia
- Epworth Healthcare Melbourne VIC Australia
| | | | - N. M. Corcoran
- Department of Urology Royal Melbourne Hospital Melbourne VIC Australia
- Epworth Healthcare Melbourne VIC Australia
| | - J. Kearsley
- Department of Urology Royal Melbourne Hospital Melbourne VIC Australia
- Epworth Healthcare Melbourne VIC Australia
| | - P. Dundee
- Department of Urology Royal Melbourne Hospital Melbourne VIC Australia
- Department of Urology Western Health Melbourne VIC Australia
- Epworth Healthcare Melbourne VIC Australia
| | - D. K. Agarwal
- Department of Urology Royal Melbourne Hospital Melbourne VIC Australia
- Department of Urology Western Health Melbourne VIC Australia
- Epworth Healthcare Melbourne VIC Australia
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11
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Chow* K, Ryan A, Agarwal D, Bolton D, Chan Y, Dundee P, Frydenberg M, Furrer M, Goad J, Gyomber D, Hanegbi U, Harewood L, King D, Lawrentschuk N, Lamb A, Liodakis P, Moon D, Murphy D, Peters J, Ruljancich P, Verrill C, Webb D, Wong LM, Zargar H, Costello A, Hovens C, Corcoran N. MP64-09 DUCTAL ADENOCARCINOMA OF THE PROSTATE IS ASSOCIATED WITH SHORTER METASTASIS-FREE SURVIVAL. J Urol 2020. [DOI: 10.1097/ju.0000000000000939.09] [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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12
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Genitsch V, Kollár A, Vandekerkhove G, Blarer J, Furrer M, Annala M, Herberts C, Pycha A, de Jong JJ, Liu Y, Krentel F, Davicioni E, Gibb EA, Kruithof-de Julio M, Wyatt AW, Seiler R. Morphologic and genomic characterization of urothelial to sarcomatoid transition in muscle-invasive bladder cancer. Urol Oncol 2019; 37:826-836. [PMID: 31585777 DOI: 10.1016/j.urolonc.2019.09.025] [Citation(s) in RCA: 12] [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: 03/04/2019] [Revised: 06/22/2019] [Accepted: 06/23/2019] [Indexed: 01/05/2023]
Abstract
INTRODUCTION The sarcomatoid morphology of muscle-invasive bladder cancer (MIBC) is associated with unfavorable prognosis. However, the genomic, transcriptomic, and proteomic relationship between conventional urothelial and synchronous sarcomatoid morphology is poorly defined. METHODS We compiled a cohort of 21 MIBC patients with components of conventional urothelial and adjacent sarcomatoid morphology within the same tumor focus. We performed comprehensive pathologic and immunohistochemical characterization and in 4 selected cases, subjected both morphologic components to targeted DNA sequencing and whole transcriptome analysis. RESULTS Synchronous sarcomatoid and urothelial morphology from the same MIBC foci shared truncal somatic mutations, indicating a common ancestral clone. However, additional mutations or copy number alterations restricted to the either component suggested divergent evolution at the genomic level. This was confirmed at the transcriptome level since while the urothelial component exhibited a basal-like subtype (TCGA2014: cluster III, LundTax: basal/squamous-like), the sarcomatoid morphology was predominantly cluster IV (claudin-low). Protein expression was consistent with a basal-like phenotype in both morphologies in 18/21 of cases. However, most cases had evidence of active epithelial-to-mesenchymal transition (E-Cad ↓ and Zeb1 or TWIST1 ↑) from urothelial toward the sarcomatoid morphology. Drug response signatures nominated different targets for each morphology and proposed agents under clinical investigation in liposarcoma or other sarcoma. PD-L1 expression was higher in the sarcomatoid than the urothelial component. CONCLUSIONS Conventional urothelial and adjacent sarcomatoid morphologies of MIBC arise from the same common ancestor and share a basal-like phenotype. However, divergence between the morphologies at the genome, transcriptome, and proteome level suggests differential sensitivity to therapy.
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Affiliation(s)
- Vera Genitsch
- Institute of Pathology, University of Bern, Switzerland
| | - Attila Kollár
- Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Gillian Vandekerkhove
- Vancouver Prostate Centre and Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
| | - Jennifer Blarer
- Department of Urology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Marc Furrer
- Department of Urology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Matti Annala
- Vancouver Prostate Centre and Department of Urologic Sciences, University of British Columbia, Vancouver, Canada; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Cameron Herberts
- Vancouver Prostate Centre and Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
| | - Armin Pycha
- Department of Urology, Central Hospital of Bolzano, Bolzano, Italy
| | - Joep J de Jong
- Department of Urology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Yang Liu
- GenomeDx Inc., Vancouver, Canada
| | - Friedemann Krentel
- Vancouver Prostate Centre and Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
| | | | | | | | - Alexander W Wyatt
- Vancouver Prostate Centre and Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
| | - Roland Seiler
- Department of Urology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
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Genitsch V, Kollár A, Vandekerkhove G, Blarer J, Furrer M, Annala M, Herberts C, Pycha A, de Jong JJ, Liu Y, Krentel F, Davicioni E, Gibb EA, Kruithof-de Julio M, Wyatt AW, Seiler R. Morphologic and genomic characterization of urothelial to sarcomatoid transition in muscle-invasive bladder cancer. Urol Oncol 2019; 37:573.e19-573.e29. [PMID: 31358384 DOI: 10.1016/j.urolonc.2019.06.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 06/22/2019] [Accepted: 06/23/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The sarcomatoid morphology of muscle-invasive bladder cancer (MIBC) is associated with unfavorable prognosis. However, the genomic, transcriptomic, and proteomic relationship between conventional urothelial and synchronous sarcomatoid morphology is poorly defined. METHODS We compiled a cohort of 21 MIBC patients with components of conventional urothelial and adjacent sarcomatoid morphology within the same tumor focus. We performed comprehensive pathologic and immunohistochemical characterization and in 4 selected cases, subjected both morphologic components to targeted DNA sequencing and whole transcriptome analysis. RESULTS Synchronous sarcomatoid and urothelial morphology from the same MIBC foci shared truncal somatic mutations, indicating a common ancestral clone. However, additional mutations or copy number alterations restricted to the either component suggested divergent evolution at the genomic level. This was confirmed at the transcriptome level since while the urothelial component exhibited a basal-like subtype (TCGA2014: cluster III, LundTax: basal/squamous-like), the sarcomatoid morphology was predominantly cluster IV (claudin-low). Protein expression was consistent with a basal-like phenotype in both morphologies in 18/21 of cases. However, most cases had evidence of active epithelial-to-mesenchymal transition (E-Cad ↓ and Zeb1 or TWIST1 ↑) from urothelial toward the sarcomatoid morphology. Drug response signatures nominated different targets for each morphology and proposed agents under clinical investigation in liposarcoma or other sarcoma. PD-L1 expression was higher in the sarcomatoid than the urothelial component. CONCLUSIONS Conventional urothelial and adjacent sarcomatoid morphologies of MIBC arise from the same common ancestor and share a basal-like phenotype. However, divergence between the morphologies at the genome, transcriptome, and proteome level suggests differential sensitivity to therapy.
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Affiliation(s)
- Vera Genitsch
- Institute of Pathology, University of Bern, Switzerland
| | - Attila Kollár
- Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Gillian Vandekerkhove
- Vancouver Prostate Centre and Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
| | - Jennifer Blarer
- Department of Urology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Marc Furrer
- Department of Urology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Matti Annala
- Vancouver Prostate Centre and Department of Urologic Sciences, University of British Columbia, Vancouver, Canada; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Cameron Herberts
- Vancouver Prostate Centre and Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
| | - Armin Pycha
- Department of Urology, Central Hospital of Bolzano, Bolzano, Italy
| | - Joep J de Jong
- Department of Urology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Yang Liu
- GenomeDx Inc., Vancouver, Canada
| | - Friedemann Krentel
- Vancouver Prostate Centre and Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
| | | | | | | | - Alexander W Wyatt
- Vancouver Prostate Centre and Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
| | - Roland Seiler
- Department of Urology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
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Gross T, Furrer M, Schorno P, Wuethrich PY, Schneider MP, Thalmann GN, Burkhard FC. Reproductive organ-sparing cystectomy significantly improves continence in women after orthotopic bladder substitution without affecting oncological outcome. BJU Int 2018. [DOI: 10.1111/bju.14191] [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] [Indexed: 12/01/2022]
Affiliation(s)
- Tobias Gross
- Department of Urology; University of Bern; Bern Switzerland
- Department of Urology; Royal Melbourne Hospital; Parkville Vic. Australia
| | - Marc Furrer
- Department of Urology; University of Bern; Bern Switzerland
| | - Petra Schorno
- Department of Urology; University of Bern; Bern Switzerland
| | - Patrick Y. Wuethrich
- Department of Anaesthesiology and Pain Medicine; University of Bern; Bern Switzerland
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Wen Wu FM, Burkhard F, Turri F, Furrer M, Loeffel L, Thalmann G, Wuethrich P. Renal outcome after radical cystectomy and urinary diversion performed with restrictive hydration and vasopressor administration in the frame of an enhanced recovery program: A follow-up study of a randomized clinical trial. Urol Oncol 2017. [DOI: 10.1016/j.urolonc.2017.05.024] [Citation(s) in RCA: 5] [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: 11/26/2022]
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16
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Schwab TR, Stillhard PF, Schibli S, Furrer M, Sommer C. Radial nerve palsy in humeral shaft fractures with internal fixation: analysis of management and outcome. Eur J Trauma Emerg Surg 2017; 44:235-243. [PMID: 28280873 PMCID: PMC5884898 DOI: 10.1007/s00068-017-0775-9] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [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: 09/14/2016] [Accepted: 02/21/2017] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The incidence of radial nerve injury after humeral shaft fractures is on average 11.8% (Shao et al., J Bone Jt Surg Br 87(12):1647-1652, 2005) representing the most common peripheral nerve injury associated with long bone fractures (Korompilias et al., Injury, 2013). The purpose of this study was to analyze our current policy and long-term outcome, regarding surgically treated humeral shaft fractures in combination with radial nerve palsy. MATERIALS AND METHODS We retrospectively analyzed the data of patients with surgically treated humeral shaft fractures from 01/01/2003 to 28/02/2013. The analysis included fracture type, soft tissue injury regarding closed and open fractures, type of fixation, management, and outcome of radial nerve palsy. RESULTS A total of 151 humeral shaft fractures were fixed in our hospital. In 20 (13%) cases, primary radial palsy was observed. Primary nerve exploration was performed in nine cases. Out of the 13 patients with follow-up, 10 showed a complete, 2 a partial, and 1 a minimal nerve recovery. Two of them underwent a revision procedure. Secondary radial nerve palsy occurred in 9 (6%) patients postoperatively. In five patients, the radial nerve was not exposed during the initial surgery and, therefore, underwent revision with nerve exploration. In all 5, a potential cause for the palsy was found and corrected as far as possible with full recovery in 3 and minimal recovery in one patient. In four patients with exposure of the nerve during the initial surgery, no revision was performed. All of these 4 showed a full recovery. CONCLUSION Our study showed an overall rate of 19% radial nerve palsy in surgically treated humeral shaft fractures. Most of the primary palsies (13%) recovered spontaneously, and therefore, nerve exploration was only exceptionally needed. The incidence of secondary palsy after surgery (6%) was high and mainly seen after plate fixation. In these cases, we recommend early nerve exploration, to detect and treat potential curable neural lesions.
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Affiliation(s)
- T R Schwab
- Kantonsspital Graubünden, Loestrasse 170, 7000, Chur, Switzerland.
| | - P F Stillhard
- Kantonsspital Graubünden, Loestrasse 170, 7000, Chur, Switzerland
| | - S Schibli
- Kantonsspital Graubünden, Loestrasse 170, 7000, Chur, Switzerland
| | - M Furrer
- Kantonsspital Graubünden, Loestrasse 170, 7000, Chur, Switzerland
| | - C Sommer
- Kantonsspital Graubünden, Loestrasse 170, 7000, Chur, Switzerland
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Moltzahn F, Dal Pra A, Furrer M, Thalmann G, Spahn M. Urethral strictures after radiation therapy for prostate cancer. Investig Clin Urol 2016; 57:309-15. [PMID: 27617311 PMCID: PMC5017559 DOI: 10.4111/icu.2016.57.5.309] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 04/06/2016] [Accepted: 06/27/2016] [Indexed: 11/18/2022] Open
Abstract
Urethral stricture after radiation therapy for localized prostate cancer is a delicate problem as the decreased availability of tissue healing and the close relation to the sphincter complicates any surgical approach. We here review the pathophysiology, dosimetry, and the disease specific aspects of urethral strictures after radiotherapy. Moreover we discuss different treatment option such as direct vision internal urethrotomy as well as techniques for open reconstruction with and without tissue transfer.
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Affiliation(s)
- Felix Moltzahn
- Department of Urology, Inselspital Bern, Bern, Switzerland
| | - Alan Dal Pra
- Department of Radiation-Oncology, Inselspital Bern, Bern, Switzerland
| | - Marc Furrer
- Department of Urology, Inselspital Bern, Bern, Switzerland
| | | | - Martin Spahn
- Department of Urology, Inselspital Bern, Bern, Switzerland
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Michelitsch C, Acklin Y, Hässig G, Sommer C, Furrer M. F-030OPERATIVE STABILIZATION OF CHEST WALL TRAUMA: SINGLE-CENTRE REPORT OF INITIAL MANAGEMENT AND LONG-TERM OUTCOME. Interact Cardiovasc Thorac Surg 2016. [DOI: 10.1093/icvts/ivw260.30] [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: 11/12/2022] Open
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Furrer M, Nguyen DP, Gross T, Thalmann GN, Studer UE. MP38-17 ATTEMPTED NERVE SPARING HAS A LONG TERM IMPACT ON URINARY CONTINENCE IN PATIENTS WITH AN ORTHOTOPIC BLADDER SUBSTITUTE. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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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Abstract
Incidentally found solitary pulmonary nodules (SPN) are increasing due to liberal use of high resolution CT scans. SPNs are defined as densities up to 3cm without associated enlarged lymph nodes. Morphologic patterns of the SPN in CT or dynamic changes in serial investigations as well as the individual risk profile (age, smoking history, current or past malignant disease) are crucial to classify the likelihood of malignancy as low, intermediate or high. Whereas low risk SPNs have to be observed by serial CT scans, intermediate risk SPNs have to be evaluated by transthoracic or bronchoscopic biopsies. However, these investigations are only reliable if malignant or specific benign diseases can be clearly diagnosed in the obtained tissue. In all the other cases, SPNs remain undetermined and surgical resection is mandatory. Increasingly, FDG-PET is performed in patients with intermediate risk SPNs and a high risk for surgery aiming to further determine the pre-test probability of malignant disease. Its sensitivity is about 80%. Nodules with high FDG uptake are suspect to be malignant and surgical removal is indicated. SPN with a high likelihood to be malignant are usually resected surgically as a primary approach. In case of metastasis, excisional biopsy may be therapeutic. The surgical method of choice is the video assisted thoracoscopic (VATS) wedge resection. Ideal for this method are nodules of 1 to 2 cm in diameter not localised deeper within lung parenchyma than its own diameter. If a SPN is diagnosed intraoperatively to be a non-small cell lung cancer, anatomic resection can be performed under the same anaesthesia. SPNs diagnosed to be cancer often are early stage tumours. Therefore, lobectomy and lymphadenectomy can also be made in VATS technique. In rare cases, diagnostic thoracotomy may still be necessary to definitely determine the aetiology of a SPN. An interdisciplinary approach is crucial to plan an efficient and individualised work-up of SPNs.
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Affiliation(s)
- M Odermatt
- Thoraxchirurgie, Departement Chirurgie, Kantonsspital Graubünden, Chur
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Wyss TR, Heller G, Furrer M. Challenging narrow distal aorta in abdominal aortic aneurysm--endovascular repair using a reversed flared endoprosthesis. Eur J Vasc Endovasc Surg 2012; 43:681-3. [PMID: 22459799 DOI: 10.1016/j.ejvs.2012.02.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 02/26/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Narrow aortic bifurcations are a challenging issue while treating abdominal aortic aneurysm by endovascular means. Off-the-shelf products are often not suitable and special considerations and custom-made endoprostheses are necessary. REPORT Alternatively, some morphologies qualify for a flared tube graft. We report two successful aneurysm exclusions using custom-made (Anaconda, Vascutek/Terumo) step-down diameter grafts in patients with tight distal aortas without the need for pre-interventional endograft adjustments. DISCUSSION In these two cases, implantation of a custom-made proximally flared tube endograft in treating a localised abdominal aortic aneurysm with a narrow and calcified bifurcation seems feasible. They represent uncommon, yet challenging, issues worthy of attention.
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Affiliation(s)
- T R Wyss
- Department of Surgery, Division of Vascular Surgery, Kantonsspital Graubuenden, Loestrasse 170, Chur, Switzerland.
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Schwitter M, Potocnik P, von Moos R, Frick H, Furrer M, Cathomas R. Dyspnoea and a lung mass in a young female 2 weeks after Caesarean delivery. Eur Respir J 2011; 38:465-7. [PMID: 21804162 DOI: 10.1183/09031936.00187210] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Montemurro M, Dirnhofer S, Borner M, Burkhard R, Demartines N, Furrer M, Guillou L, Kettelhack C, Knüsli C, Langer I, Metzger U, Redaelli C, Tornillo L, von Flüe M, von Moos R, Leyvraz S. Diagnose und Behandlung von Gastrointestinalen Stromatumoren (GIST) in der Schweiz. ACTA ACUST UNITED AC 2008. [DOI: 10.4414/smf.2008.06542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Nava A, Mazza E, Furrer M, Villiger P, Reinhart W. In vivo mechanical characterization of human liver. Med Image Anal 2008; 12:203-16. [DOI: 10.1016/j.media.2007.10.001] [Citation(s) in RCA: 160] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2006] [Revised: 10/01/2007] [Accepted: 10/02/2007] [Indexed: 12/01/2022]
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Affiliation(s)
- A. Schweizer
- Department of Plastic-, Reconstructive- and Hand Surgery, Kantonsspital Aarau AG, Tellstrasse, CH-5001 Aarau, Switzerland
| | - M. Furrer
- Department of Plastic-, Reconstructive- and Hand Surgery, Kantonsspital Aarau AG, Tellstrasse, CH-5001 Aarau, Switzerland
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Furrer M, Schweizer A, Meuli-Simmen C. Aplasia of the flexor digitorum profundus tendon of the small finger. J Hand Surg Eur Vol 2007; 32:111-2. [PMID: 17097203 DOI: 10.1016/j.jhsb.2006.09.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2006] [Revised: 09/19/2006] [Accepted: 09/20/2006] [Indexed: 02/03/2023]
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Betticher DC, Hsu Schmitz SF, Tötsch M, Hansen E, Joss C, von Briel C, Schmid RA, Pless M, Habicht J, Roth AD, Spiliopoulos A, Stahel R, Weder W, Stupp R, Egli F, Furrer M, Honegger H, Wernli M, Cerny T, Ris HB. Prognostic factors affecting long-term outcomes in patients with resected stage IIIA pN2 non-small-cell lung cancer: 5-year follow-up of a phase II study. Br J Cancer 2006; 94:1099-106. [PMID: 16622435 PMCID: PMC2361244 DOI: 10.1038/sj.bjc.6603075] [Citation(s) in RCA: 163] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The aim was to investigate the efficacy of neoadjuvant docetaxel-cisplatin and identify prognostic factors for outcome in locally advanced stage IIIA (pN2 by mediastinoscopy) non-small-cell lung cancer (NSCLC) patients. In all, 75 patients (from 90 enrolled) underwent tumour resection after three 3-week cycles of docetaxel 85 mg m-2 (day 1) plus cisplatin 40 or 50 mg m-2 (days 1 and 2). Therapy was well tolerated (overall grade 3 toxicity occurred in 48% patients; no grade 4 nonhaematological toxicity was reported), with no observed late toxicities. Median overall survival (OS) and event-free survival (EFS) times were 35 and 15 months, respectively, in the 75 patients who underwent surgery; corresponding figures for all 90 patients enrolled were 28 and 12 months. At 3 years after initiating trial therapy, 27 out of 75 patients (36%) were alive and tumour free. At 5-year follow-up, 60 and 65% of patients had local relapse and distant metastases, respectively. The most common sites of distant metastases were the lung (24%) and brain (17%). Factors associated with OS, EFS and risk of local relapse and distant metastases were complete tumour resection and chemotherapy activity (clinical response, pathologic response, mediastinal downstaging). Neoadjuvant docetaxel-cisplatin was effective and tolerable in stage IIIA pN2 NSCLC, with chemotherapy contributing significantly to outcomes.
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Affiliation(s)
- D C Betticher
- Clinic of Medical Oncology, Hospital of Fribourg, 1700 Fribourg, Switzerland.
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Pecinska N, Nussbaumer P, Furrer M. [Acute vascular occlusion of the upper extremity after blunt trauma]. VASA 2005; 34:201-2. [PMID: 16184842 DOI: 10.1024/0301-1526.34.3.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Intimal ruptures after blunt trauma without joint dislocation are rare. We report the case of a 62 year old male patient presenting with paraesthesia in the fingers I to III and a cool left hand after a blunt trauma of the upper arm. Non-invasive examination documented the thrombotic occlusion of the axillary artery. Due to a circular rupture of the intima surgical revascularization was performed with a vein graft.
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Affiliation(s)
- N Pecinska
- Department Chirurgie, Rätisches Kantons- und Regionalspital Chur, Schweiz
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Abstract
Systems that record critical incidents were initially developed for aeronautics and are being increasingly applied in medicine. The objective is to detect problems inherent to systems and system errors before they lead to complications or do harm to patients. We report our preliminary experience with a critical incident reporting system (CIRS). Since February 1 2001, all employees of our surgical department have been able to report incidents, anonymously or candidly, to a central board using a standardized documentation form. The results are presented at monthly internal quality meetings, where two to three crucial incidences are thoroughly discussed. New information is communicated and put into practice as quickly as possible. A total of 424 incidents were reported from February 1, 2001 to December 31, 2003. Reversible damages, some of which resulted in prolonged hospitalization, were consequential to 22% of the cases. Thirteen percent were classified as "near miss" (almost incidents), whereas 65% had no consequences for patients. As expected, doctors and nurses were most frequently involved, as 36% of the reported incidents occurred in connection with the prescription and administration of medication. In particular, the near miss category revealed system errors which in 85% of cases had immediate consequences for therapeutic procedures. Based on our initial experiences, working with CIRS may be evaluated as positive. The open discussion of incidents and errors also revealed minor but often significant system errors, which resulted in alteration of our internal proceedings and thus improved the quality and safety of treatment.
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Furrer M, De Monaco D, Kammer E, Meuli-Simmen C. Wieviel darf Mikrochirurgie kosten? HANDCHIR MIKROCHIR P 2005. [DOI: 10.1055/s-2005-864866] [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: 10/19/2022] Open
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Abstract
The widespread acceptance of minimal invasive techniques has revolutionized the practice of surgery including, thoracic surgery. Within a short period of time, video-assisted thoracic surgery (VATS) has become an acceptable approach to a wide range of thoracic procedures. The use of VATS as a diagnostic modality is now well established. For therapeutic procedures, VATS has also been generally accepted as the treatment for spontaneous pneumothorax, thoracic sympathectomy, treatment of loculated effusions and resection of simple mediastinal cysts and benign tumors. Its role in major procedures, e.g. anatomic lung resections and thymectomy, however, remain poorly defined at present although some of the existing intermediate results are encouraging. The technique continues to evolve, with further miniaturization to reduce access-induced trauma. No matter how attractive the new techniques may appear, carefully conducted clinical trials should precede the general acceptance and widespread use.
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Affiliation(s)
- P Nussbaumer
- Departement Chirurgie, Kantonsspital, Spitäler Chur AG, Chur
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Furrer M. The Mandate of the International Committee of the Red Cross for the Protection of Internally Displaced Persons. Refugee Survey Quarterly 2005. [DOI: 10.1093/rsq/hdi055] [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: 11/14/2022]
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Ruzicka L, Plattner PA, Furrer M. Über Steroide und Sexualhormone. (96. Mitteilung). Über Umwandlungsprodukte des 2-Acetoxy-cholestanons-(3). Helv Chim Acta 2004. [DOI: 10.1002/hlca.19440270191] [Citation(s) in RCA: 13] [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: 11/06/2022]
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Abstract
The management of patients suffering from abdominal aortic aneurysms with concomitant intestinal disease is demanding. Surgical procedures have to be evaluated meticulously with regard to morbidity and priority. We retrospectively investigated early and late results of nine patients (eight males, one female) with coincidental aortic and intestinal surgery during the last 9.5 years. The average age was 77 years (range 67-85). One-stage procedures were undertaken twice with implantation of aortic grafts to replace abdominal aortic aneurysms (AAA). During these emergency procedures, an aortoduodenal fistula was repaired in one case and resection of an ischemic segment of the sigmoid colon was resected in another. Seven two-stage procedures were performed as elective surgery. Five AAA were excluded before the intestinal repair. In two cases of urgent visceral pathologies, colon resection was done first, followed by elimination of the AAA. In case of elective surgery, two-stage procedures seem to be safe and effective. However, in certain emergent cases, one-stage procedures with implantation of vascular grafts in combination with colon or bowel surgery might also be justified.
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Affiliation(s)
- L Mathys
- Departement Chirurgie, Rätisches Kantonsspital, Chur, Schweiz
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Friesewinkel O, Furrer M, Hänggi G, Rutschmann A. [Severe heart failure: treatment optimisation and monitoring using plasma NT-proBNP levels--an useful tool in clinical practice]. Praxis (Bern 1994) 2004; 93:476-480. [PMID: 15072235 DOI: 10.1024/0369-8394.93.12.476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
A young patient presented with a cardiomegaly of unknown origin. The cardiologic examination revealed a severe eccentric left ventricular hypertrophy and a dilatation of the other heart cavities as well as a strongly impaired global systolic function. The patient was treated with an ACE inhibitor, a diuretic and with a beta-blocking agent. The dosages of which were adapted accordingly to the plasma concentration of N-terminal-pro-brain-natriuretic peptide (NT-proBNP). After five months of treatment, a decrease of the NT-proBNP level to nearly normal values along with a significant reduction of the heart dimensions and a substantial improvement of left ventricular function were found.
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Drinkuth S, Segmüller H, Furrer M, von Wartburg U. Parosteal osteosarcoma of the distal ulna. A rare tumour at a rare location: a case report. Chir Main 2003; 22:104-8. [PMID: 12822246 DOI: 10.1016/s1297-3203(03)00024-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We report a case of a histologically well differentiated, grade I, parosteal osteosarcoma of the distal ulna. The tumour's radiological and histological features are described, and the patient's course after wide en-bloc resection is detailed. Parosteal osteosarcoma is a rare low-grade malignant neoplasm. It belongs to the group of the osteosarcomas originating from the surface of the bone, representing a distinct tumour entity within this group, with defined histological and radiological features. We describe the radiological and histological characteristics of parosteal osteosarcoma and, based upon these features, present its classification. The differential diagnosis, including parosteal osteoma, myositis ossificans and osteochondroma, is also discussed. Finally, therapy and prognosis are outlined in accordance with the current literature. Wide en-bloc resection represents the mainstay of therapy offering an excellent prognosis with a 5-year survival rate of more than 90%. Incomplete resection, on the other hand, increases the risk of recurrence and dedifferentiation of the tumour. Dedifferentiation induces tumour spread and is associated with a poor prognosis equivalent to conventional osteosarcoma.
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Affiliation(s)
- Sabine Drinkuth
- Department of Hand and Plastic Surgery, Kantonsspital, Lucerne, Switzerland.
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Candrian C, Nussbaumer P, Furrer M. [Bilateral popliteal artery entrapment syndrome. Is preventive operation on the asymptomatic side indicated?]. Swiss Surg 2003; 8:224-9. [PMID: 12422769 DOI: 10.1024/1023-9332.8.5.224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Popliteal artery entrapment is a rare cause of claudication symptoms, but should always be included in the differential diagnosis of lower limb ischaemia in young patients, especially men. On an embryological basis, PAES is the result of the abnormal development of the popliteal artery or the gastrocnemius muscle. The anomaly is manifested as one of four types. Untreated, the entrapment results in the deterioration of the artery, resulting in eventual occlusion. Presenting the case of a 37 year old female patient with bilateral PAES and a review of the literature we discuss the clinical findings, diagnosis, treatment options and the management of the often asymptomatic opposite side.
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Affiliation(s)
- C Candrian
- Chirurgisches Departement, Rätisches Kantons- und Regionalspital Chur.
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Candrian C, Ruedi T, Furrer M. [Merkel cell carcinoma. Retrospective analysis of 4 cases with special reference to diagnosis, therapy and long-term outcome]. Swiss Surg 2003; 8:215-9. [PMID: 12422767 DOI: 10.1024/1023-9332.8.5.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Merkel cell carcinoma is an aggressive neuro-endocrine skin tumor with early regional lymph node involvement and early distant metastases. Diagnostic work-up may be difficult because of the low incidence of the tumor. Treatment concepts are individual and long-term-outcome are varying markedly. METHODS Retrospective analyse of four cases with special regard to the diagnostic, therapeutic approach and the long-term follow-up. RESULTS In every case diagnosis has only been made histologically. In the first patient, suffering from a tumor on the upper arm, after the tumor removal, local and axillary radiotherapy has been performed. In a second case with an extended tumor on the shank, a palliative tumor-debulking was followed by a chemo- and radiotherapy. The third Patient had a tumor in the gluteal region with involvement of the regional lymph nodes. He was treated by a complete surgical excision and lymphadenectomy followed by a local radiotherapy with subsequent chemotherapy. The fourth patient with tumor on the elbow, without lymph node involvement, refused surgical intervention, therefore she has been treated by radio- and chemotherapy. All patients are respectively 1.2 and 3 years are alive without evidence of recurrence. One patient died after 1.5 year because of tumor relapse. CONCLUSION Diagnosis of Merkel cell carcinoma is difficult and is established only by in- or excision biopsy of the tumor. If ever possible surgical excision combined with regional lymphadenectomy should be performed. Adjuvant radiotherapy is established, whereas the value of chemotherapy has not yet be defined and might be beneficial only in cases of expansive or disseminated growth. In our series we did encounter the often described metastatic involvement of other organs just in one case.
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Affiliation(s)
- C Candrian
- Chirurgisches Departement, Rätisches Kantons- und Regionalspital Chur.
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Derungs U, Nussbaumer P, Sommer C, Leutenegger A, Furrer M. [How often do surgical residents operate in a category A non-university post-graduate teaching hospital?]. Swiss Surg 2003; 9:257-62. [PMID: 14725093 DOI: 10.1024/1023-9332.9.6.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
INTRODUCTION After introduction of the new postgraduate training program for general surgery the completion of the operation list still represents the most important step. Based on our number of operations we examined whether residents would carry out the requested interventions at our non-university teaching hospital (category A). METHOD For eight tracer operations we retrospectively counted the number of cases of the non private patients from 1998-2002 and took account of the postgraduate education status of the operator. In this period the team consisted of 51 residents (71 education years), of whom 18 candidates for general surgery who carried out the interventions (35 education years, inclusive rotation in ICU, emergency room and special surgical disciplines). RESULTS Regarding all tracer operations, the amount of interventions per year and candidate which are necessary to accomplish the goal for the first four years of education are reached: appendectomy 8.9, laparoscopic cholecystectomy 7.3, open inguinal hernia repair 9.4, varicose veins operation 12.1, open colon sigmoideum resection 3.2, hip and malleolar fracture 6.9, hemithyreoidectomy 5. CONCLUSION Completion of the operation list as the major training goal was reached at our institution. Following our structured education program the demands regarding postgraduate education will be met also in future. Further studies however, must examine the impact of the new resident's work contracts dictating a reduction of the weekly working hours.
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Affiliation(s)
- U Derungs
- Departement Chirurgie, Rätisches Kantons- und Regionalspital, Chur
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Scheidegger EP, Späth PJ, Furrer M, Vogt M, Fontana A, Wüthrich B. Malignancy masquerading as food hypersensitivity. Allergy 2001; 56:349. [PMID: 11284805 DOI: 10.1034/j.1398-9995.2001.00074.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- E P Scheidegger
- Department of Dermatology, University Hospital Zurich, Switzerland
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Furrer M, Rüedi T. Therapeutische Umschau 2001; 058:0693-0693. [DOI: 10.1024/0040-5930.58.12.693] [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: 11/19/2022]
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Abstract
BACKGROUND Relatively few data are available about Haemophilus influenzae (Hi) infection among adults. MATERIALS AND METHODS We studied all adult patients with Hi infection hospitalized between 1988 and 1997 at the University Hospital of Berne. Data were abstracted retrospectively from clinical charts and microbiology records using a standardized questionnaire. RESULTS 12 invasive and 19 noninvasive Hi infections were observed during the study period. The main clinical manifestations were pneumonia (38.7%), bronchitis (29.0%) and meningitis (12.9%). Most patients (71.8%) had an underlying condition. Lethality was high (22.6%), especially in pneumonia patients (50%). The frequency of meningitis caused by Hi serotype b (Hib) seemed to decrease after 1990 when conjugated vaccines against Hib were introduced. CONCLUSION Hi remains an important cause of lower respiratory and invasive disease associated with high lethality among polymorbid adult patients. The frequency of Hib infections may also decrease in adults due to herd immunity induced by universal vaccination of children.
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Affiliation(s)
- M Furrer
- Institute of Medical Microbiology, University of Berne, Switzerland
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Furrer M. [Controversies in the treatment of carotid stenosis]. Schweiz Med Wochenschr 2000; 130:1225. [PMID: 11013926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Affiliation(s)
- M Zurkirchen
- Department of Surgery, Kantonsspital, Chur, Switzerland
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Abstract
BACKGROUND AND OBJECTIVES Thoracoscopic sympathectomy, for years an effective way to treat mainly palmar and axilla hyperhidrosis, experienced a revival since the application of the principles of minimally invasive surgery. We report the personal experiences of three surgeons with this technique, as well as patients' view of the outcome. PATIENTS AND METHODS Between January 1990 and November 1997, 73 procedures were performed in 43 patients (23 males, 20 females, mean age 38.1 years, range 15-82 years), and the outcome was prospectively studied. Palmar hyperhidrosis without axilla symptoms was the indication for the operation in 27 patients (54 sympathectomies), Raynaud's syndrome in 15 (18 sympathectomies), and causalgia in one. Thoracic ganglia 2-4 were always completely resected. Perioperative morbidity as well as patient satisfaction in the long-term course (standardized interview) 25.8 (1-77) months postoperatively were assessed. RESULTS The complication rate in all 73 sympathectomies was 8.2%. Only two severe incidents were observed: in one patient intermittent Horner's syndrome (1.4%) occurred, and in another severe bleeding required conversion to open surgery (1.4%). Both complications occurred in the early study phase. The initial success rate in all 27 patients with hyperhidrosis was 100%. In 30% of these cases a mild partial relapse was observed, which did not interfere with their daily activities. 53% of the patients reported compensatory and 23% gustatory sweating. 9% would have refused the operation, had they known these side effects. In all patients with Raynaud's disease the ulcerations healed completely. At the time of the interview, two patients (13%) complained of painless relapses. They too stated that they had refused the operation, if they had known about the relapses. CONCLUSIONS Even in the longer-term course, thoracoscopic sympathectomy is rated subjectively successful by 93% of patients after treatment of hyperhidrosis of the upper extremities, and by 87% of patients after treatment of Raynaud's disease, despite some untoward effects and partial relapses.
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Abstract
BACKGROUND All patients with extensive resection of the anterolateral chest wall and the sternum followed by reconstruction with methylmethacrylate substitutes were assessed prospectively 6 months after the operation to delineate chest wall integrity with pulmonary function and cine-magnetic resonance imaging. METHODS Twenty-six patients underwent chest wall reconstruction by use of methylmethacrylate between 1994 and 1998 due to primary tumors in 35%, metastases in 27%, T3 lung cancer in 19%, and debridement for radionecrosis and osteomyelitis in 19% of patients. Three to eight ribs were resected and additional sternum resection was performed in 39% of patients. RESULTS There was no 30-day mortality. All patients were extubated after the operation without need for reintubation. Prosthesis dislocation occurred in 1 patient and infection in 2 patients during follow-up. Nineteen patients (73%) suffered no restrictions of daily activities. Clinical examination revealed normal shoulder girdle function in 77% of patients. There was no significant difference between preoperative and postoperative FEV1 (forced expiratory volume in 1 second) measurements in patients with lobectomy or wedge resections. Cinemagnetic resonance imaging revealed concordant chest wall movements during respiration in 92% of patients without paradoxical movements or implant dislocations being observed. CONCLUSIONS Large defects of the anterolateral chest wall and sternum can be reconstructed efficiently with methylmethacrylate substitutes with minimal morbidity and excellent cosmetic and functional outcome.
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Affiliation(s)
- D Lardinois
- Department of Thoracic and Cardiovascular Surgery, University Hospital, University of Bern, Switzerland
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Mouton W, Fischer G, Striffeler H, Furrer M, Stettbacher A, Lardinois D, Ris HB. Is the function of the serratus anterior muscle disturbed following division during a standard thoracotomy? Thorac Cardiovasc Surg 1999; 47:188-9. [PMID: 10443523 DOI: 10.1055/s-2007-1013139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In a prospective study the functional results after dissection or preservation of the serratus anterior muscle in the postero-lateral standard thoracotomy were evaluated. In 14 patients of our clinic with dissection and suture and in 14 patients with preservation of the serratus muscle the muscle function was assessed and compared preoperatively, within the first two post-operative weeks, and three months after the operation by the same physiotherapists. The two groups were blinded in regard to age, original disease, and mode of intervention. We compared the wing position of the scapula in the sitting position and the positioning of the scapula at fixation of the shoulder joint in the sitting and in the supine position. Using a four-grade function assessment scheme, both groups obtained the same functional results. There was no seroma in either group. After 2.8 (2.5 to 3.0) years all the surviving patients described symmetric functional conditions. We therefore conclude that in order to achieve a better view of the operative field the serratus muscle may be dissected close to the origin if it is then readapted.
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Affiliation(s)
- W Mouton
- Department of Thoracic and Cardiovascular Surgery, Inselspital, Bern, Switzerland
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Furrer M. [The "sick" leg]. Ther Umsch 1998; 55:595. [PMID: 9828692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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Capoferri M, Furrer M, Ris HB. [Surgical diagnosis and therapy in patients with mediastinal space-occupying lesions. A retrospective analysis of 223 intervention with special reference to long-term course]. Swiss Surg 1998; 4:121-8. [PMID: 9655006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
UNLABELLED The diagnostic and therapeutic approach in patients with mediastinal masses (MM) treated at our institute between 1983 and 1993 was retrospectively reviewed. METHODS AND MATERIAL 193 patients with MM (105 males and 88 females, average age 53, ranging from 16-81) underwent 223 interventions. Staging mediastinoscopies in lung cancer patients were ruled out. Long-term follow-up data were available in 123 of 162 cases with neoplastic MM (average follow-up time 5.5 years). Of all 223 surgical interventions 143 were diagnostic (53 parasternal mediastinotomies, 78 mediastinoscopies and 8 thoracoscopies) and 80 therapeutic (46 sternotomies and 34 posterolateral and a second half). The analysed period was splitted up in a first half (1983-1987) and second half (1988-1993) to study an eventual trend in the management of MM. RESULTS The most frequent diagnoses were: thymoma (21%), malignant lymphoma (18%) and mediastinal sarcoidosis (14%). 43% of the MM were localized in the anterior, 46% in the middle and 7% in the posterior mediastinum. Thoracic pain, cough and dyspnoea represented the most common symptoms, leading to an invasive diagnostic procedure. 25% of the patients had no symptoms. The mortality and morbidity rate of all interventions was 3.4% and 18.7% respectively and concerned almost nerval injuries and postoperative respiratory failure. The percentage of direct tumor excisions increased from 21% during the first half of the period to 40% during the second half of the period, whereas diagnostic surgical interventions decreased from 57% to 44%. The percentage of total excisions after previous surgical biopsies decreased from 22% to 16%. In spite of the introduction of high resolution CT scan and MRI techniques during this time period no significant change in the use of presurgical diagnostic procedures was obvious. Fine needle biopsies and bronchoscopies were performed less frequent in the second half in comparison to the first half (11%, 7%, 29%, 13% respectively). From 123 patients with neoplastic disease data were available for long-term results. 35 had benign and 83 malignant histologies, in five cases dignity was unclear. 54% of these patients were disease-free at follow-up time, 10% had local recurrency or distant metastasis and 37% died during the observed time period. CONCLUSIONS Surgical biopsy seems to remain the most important investigation for a successful interdisciplinary approach to MM. Overall morbidity and mortality rate of mediastinal surgery might appear remarkable but has to be related to the favorous long-term results after different individual treatment modalities in patients with mediastinal masses.
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Affiliation(s)
- M Capoferri
- Universitätsklinik für Thorax-, Herz- und Gefässchirurgie, Inselspital Bern
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Furrer M, Lardinois D, Thormann W, Altermatt HJ, Betticher D, Triller J, Mettler D, Althaus U, Burt ME, Ris HB. Cytostatic lung perfusion by use of an endovascular blood flow occlusion technique. Ann Thorac Surg 1998; 65:1523-8. [PMID: 9647052 DOI: 10.1016/s0003-4975(98)00235-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Different modalities of cytostatic lung perfusion were compared regarding plasma and tissue drug concentrations to assess the efficacy of an endovascular blood flow occlusion technique. METHODS A cytostatic lung perfusion study with doxorubicin hydrochloride was performed on large white pigs (n = 12). Plasma and tissue concentrations of doxorubicin were compared for isolated lung perfusion with open cannulation (ILP), blood flow occlusion perfusion with open cannulation of the pulmonary artery alone (BFO), and intravenous drug administration (i.v.). In a fourth group, thoracotomy-free BFO perfusion was performed by endovascular balloon catheterization of the pulmonary artery (endovascular BFO). The 3 animals in this group were used to compare the doxorubicin-perfused pulmonary tissue with the contralateral nonperfused lobes after 1 month. RESULTS The mean lung tissue doxorubicin concentration at the end of perfusion was 19.8 +/- 1.6 microg/g after ILP, 27.6 +/- 2.2 microg/g after BFO (p = not significant), and 3.0 +/- 0.8 microg/g after i.v. perfusion (p < 0.01). Whereas doxorubicin was not detectable in the plasma in the ILP group, concentrations ranged from not detectable to 0.44 microg/mL in the BFO group and from 0.31 to 0.84 microg/mL in the i.v. group (p < 0.05). Mean myocardial tissue concentration was not significantly different after BFO than i.v. perfusion (1.1 +/- 0.5 microg/g and 1.8 +/- 0.1 microg/g, respectively). In the endovascular BFO group, balloon-blocked pulmonary artery perfusion was successfully performed in all animals, and after 1 month, lung tissue showed no cytostatic-induced histologic changes. CONCLUSIONS Compared with ILP, BFO cytostatic lung perfusion produced an insignificantly higher lung-tissue concentration, corresponding to a sixfold to ninefold higher level than after i.v. perfusion. Plasma drug levels during BFO perfusion were lower than during i.v. perfusion. Endovascular BFO may be a promising technique for repeated cytostatic lung perfusion.
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Affiliation(s)
- M Furrer
- Department of Thoracic and Cardiovascular Surgery, University of Berne, Switzerland.
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