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1.
Background
Subtalar arthrodesis through an open approach carries significant risk of complications. An arthroscopic approach aims to minimise damage to the soft tissue envelope to improve recovery, union and complication rates. A two portal approach through the sinus tarsi was used.Methods
A retrospective review of all patients undergoing isolated arthroscopic arthrodesis was performed.Results
Seventy-seven procedures were performed. Successful arthrodesis was achieved in 75 (97.4%). Two patients underwent successful revision arthrodesis for aseptic nonunion. There was one (1.3%) superficial infection and one (1.3%) partial sural nerve injury.Conclusions
Two-portal sinus tarsi arthroscopic subtalar arthrodesis is safe and effective. Advantages over other arthroscopic approaches are the access to all three facets of the joint, avoidance of a posterolateral portal in order to minimise risk to the sural nerve, and the ability to use the same approach to arthrodese the entire triple hindfoot joint complex. Technical tips and pitfalls are discussed. 相似文献2.
Background
We describe a previously unreported presentation of the hallucal interphalangeal joint sesamoid (HIPJS) following arthrodesis of the first metatarsophalangeal joint (MTP1).Methods
Of 438 MTP1 arthrodeses performed over a 13-year period, 12 feet returned with a painful keratoma beneath a gradually hyperextending interphalangeal joint of the great toe (IPJ1) from unexcised, unrecognized or recognized HIPJS. We identified another 7 feet with HIPJS, which did not develop symptoms after MTP1 arthrodesis. Angles at which arthrodesis had been performed were measured.Results
All big toes had been arthrodesed in good position, clinically and radiologically, with no difference between the two groups in angles subtended by the proximal phalanx of the arthrodesed big toe with the ground. Good outcomes followed surgical excision of the symptomatic HIPJS.Conclusions
The presence of a HIPJS should be excluded in the differential diagnosis of IPJ1 symptoms developing after MTP1 arthrodesis. Furthermore, one should look out for and consider prophylactic excision of a HIPJS at time of MTP1 arthrodesis. 相似文献3.
N. Gutteck H. Martin T. Hanke J.B. Matthies A. Heilmann H. Kielstein G. Gradl K.S. Delank D. Wohlrab 《Foot and Ankle Surgery》2018,24(3):208-212
Background
A number of studies report on limitations of the screw arthrodesis in severe malalignment of the hindfoot, neuropathic deformity, poor bone quality and osteoporosis.Methods
Fourteen anatomically correct polyurethane foam models of the right leg (Sawbones Europe, Malmö, Sweden) and eighteen fresh-frozen human lower leg specimens (9 pairs) were used for the comparative biomechanical testing.Results
The statistical analysis of the stiffness of the fixation developed a significant difference in favor of the plate in all test directions.Conclusions
The excellent biomechanical results are very promising and we hope for a reduction of the pseudarthrosis rate and shorten the postoperative treatment phase. 相似文献4.
Nicholas J. Giacalone William U. Shipley Rebecca H. Clayman Andrzej Niemierko Michael Drumm Niall M. Heney Marc D. Michaelson Richard J. Lee Philip J. Saylor Matthew F. Wszolek Adam S. Feldman Douglas M. Dahl Anthony L. Zietman Jason A. Efstathiou 《European urology》2017,71(6):952-960
Background
Tri-modality therapy (TMT) is a recognized treatment strategy for selected patients with muscle-invasive bladder cancer (MIBC).Objective
Report long-term outcomes of patients with MIBC treated by TMT.Design, setting, and participants
Four hundred and seventy-five patients with cT2–T4a MIBC were enrolled on protocols or treated as per protocol at the Massachusetts General Hospital between 1986 and 2013.Intervention
Patients underwent transurethral resection of bladder tumor followed by concurrent radiation and chemotherapy. Patients with less than a complete response (CR) to chemoradiation or with an invasive recurrence were recommended to undergo salvage radical cystectomy.Outcome measurements and statistical analysis
Disease-specific survival (DSS) and overall survival (OS) were calculated using the Kaplan-Meier method.Results and limitations
Median follow-up for surviving patients was 7.21 yr. Five- and 10-yr DSS rates were 66% and 59%, respectively. Five- and 10-yr OS rates were 57% and 39%, respectively. The risk of salvage cystectomy at 5 yr was 29%. In multivariate analyses, T2 disease (OS hazard ratio [HR]: 0.57, 95% confidence interval [CI]: 0.44–0.75, DSS HR: 0.51, 95% CI: 0.36–0.73), CR to chemoradiation (OS HR: 0.61, 95% CI: 0.46–0.81, DSS HR: 0.49, 95% CI: 0.34–0.71), and presence of tumor-associated carcinoma in situ (OS HR: 1.56, 95% CI: 1.17–2.08, DSS HR: 1.50, 95% CI: 1.03–2.17) were significant predictors for OS and DSS. When evaluating our cohort over treatment eras, rates of CR improved from 66% to 88% and 5-yr DSS improved from 60% to 84% during the eras of 1986–1995 to 2005–2013, while the 5-yr risk of salvage radical cystectomy rate decreased from 42% to 16%.Conclusions
These data demonstrate high rates of CR and bladder preservation in patients receiving TMT, and confirm DSS rates similar to modern cystectomy series. Contemporary results are particularly encouraging, and therefore TMT should be discussed and offered as a treatment option for selected patients.Patient summary
Tri-modality therapy is an alternative to radical cystectomy for patients with muscle-invasive bladder cancer, and is associated with comparable long-term survival and high rates of bladder preservation. 相似文献5.
Giulio Nicita Donata Villari Simone Caroassai Grisanti Michele Marzocco Vincenzo Li Marzi Alberto Martini 《European urology》2017,71(1):133-138
Background
Rectourethral fistulas (RUFs) represent an uncommon complication of pelvic surgery, especially radical prostatectomy. To date there is no standardised treatment for managing RUFs. This represents a challenge for surgeons, mainly because of the potential recurrence risk.Objective
To describe our minimally invasive transanal repair (MITAR) of RUFs and to assess its safety and outcomes.Design, setting, and participants
We retrospectively evaluated 12 patients who underwent MITAR of RUF at our centre from October 2008 to December 2014. Exclusion criteria were a fistula diameter greater than 1.5 cm, sepsis, and/or faecaluria.Surgical procedure
After fistula identification through cystoscopy and 5F-catheter positioning within the fistula, MITAR is performed using laparoscopic instruments introduced through Parks’ anal retractor. The fibrotic margins of the fistula are carefully dissected by a lozenge incision of the rectal wall, parallel to the rectal axis. Under the healthy flap of the rectal wall the urothelium is located and the fistulous tract is sutured with interrupted stitches. After a leakage test of the bladder, the rectal wall is sutured with interrupted stitches. Electrocoagulation is never used during this procedure.Measurements
Fistula closure, postoperative complications, and recurrence.Results and limitations
Median follow-up was 21 (range, 12–74) mo. Median operative time was 58 (range, 50–70) min. Median hospital stay was 1.5 (range, 1–4) d. Early surgical complications occurred in one patient (8.3%). Recurrence did not occur in any of the cases. Limitations included retrospective analysis, small case load, and lack of experience with radiation-induced fustulas.Conclusions
MITAR is a safe, effective, and reproducible procedure. Its advantages are low morbidity and quick recovery, and no need for a colostomy.Patient summary
We studied the treatment of rectourethral fistulas. Our technique, transanally performed using laparoscopic instruments, was found to be safe, feasible, and effective, with limited risk of complications. 相似文献6.
7.
Correlação entre síndrome da apneia obstrutiva e via aérea difícil na cirurgia otorrinolaringológica
Marcia Hiray Pera Maria Angela Tardelli Neil Ferreira Novo Yara Juliano Helga Cristina Almeida da Silva 《Brazilian Journal of Anesthesiology》2018,68(6):543-548
Introduction
ENT patients with obstructive sleep apnea syndrome have a tendency of collapsing the upper airways in addition to anatomical obstacles. Obstructive sleep apnea syndrome is related to the increased risk of difficult airway and also increased perioperative complications. In order to identify these patients in the preoperative period, the STOP Bang questionnaire has been highlighted because it is summarized and easy to apply.Objectives
Evaluate through the STOP Bang questionnaire whether patients undergoing ENT surgery with a diagnosis of obstructive sleep apnea syndrome have a higher risk of complications, particularly the occurrence of difficult airway.Casuistry and methods
Measurements of anatomical parameters for difficult airway and questionnaire application for clinical prediction of obstructive sleep apnea syndrome were performed in 48 patients with a previous polysomnographic study.Results
The sample detected difficult airway in about 18.7% of patients, all of them with obstructive sleep apnea syndrome. This group had older age, cervical circumference > 40 cm, ASA II and Cormack III/IV. Patients with obstructive sleep apnea syndrome had higher body mass index, cervical circumference, and frequent apnea. In subgroup analysis, the group with severe obstructive sleep apnea syndrome showed a significantly higher SB score compared to patients without this syndrome or with a mild/moderate obstructive sleep apnea syndrome.Conclusions
The STOP Bang questionnaire was not able to predict difficult airway and mild obstructive sleep apnea syndrome, but it identified marked obstructive sleep apnea syndrome. All patients with difficult airway had moderate and marked obstructive sleep apnea syndrome, although this syndrome did not involve difficult airway. The variables Cormack III/IV and BMI greater than 35 Kg.m–2 were able to predict difficult airway and obstructive sleep apnea syndrome, respectively. 相似文献8.
Sumanta Kumar Pal Jean Hoffman-Censits Hanzhe Zheng Constanze Kaiser Darren Tayama Joaquim Bellmunt 《European urology》2018,73(5):800-806
Background
Atezolizumab (anti–programmed death-ligand 1) was approved in the USA, Europe, and elsewhere for treatment-naive and platinum-treated locally advanced/metastatic urothelial carcinoma (mUC).Objective
To report efficacy and safety from an atezolizumab expanded access study.Design, setting, and participants
This single-arm, open-label study enrolled 218 patients at 36 US sites. Key eligibility criteria included progression during/following ≥1 platinum-based chemotherapy for mUC or in perioperative setting (progression within 12 mo) and Eastern Cooperative Oncology Group performance status (ECOG PS) 0–2.Intervention
Patients received atezolizumab1200 mg intravenously every 3 wk until loss of clinical benefit, unacceptable toxicity, consent withdrawal, decision to discontinue, death, atezolizumab commercial availability, or study closure.Outcome measurements and statistical analysis
Key end points reported herein included Response Evaluation Criteria in Solid Tumors v1.1 objective response rate and duration, disease control rate (DCR; response or stable disease), and safety.Results and limitations
All patients received prior systemic therapy (68% mUC; 27% adjuvant; and 26% neoadjuvant). At baseline, 57% of 214 treated patients had ECOG PS ≥1, 19% had hemoglobin <10 g/dl, and 25% had liver metastases. Median treatment duration was 9 wk (interquartile range [IQR], 6–12 wk). Median follow-up duration was 2.3 mo (IQR, 1.6–3.4 mo) overall and 2.7 mo (IQR, 2.0–3.5 mo) in patients not known to have died. Seventeen of 114 evaluable patients (15%) had objective responses (16 ongoing at study termination). DCR was 49%. Treatment-related adverse events (mostly fatigue) occurred in 98 of 214 treated patients.Conclusions
The benefit/risk profile of atezolizumab was consistent with that observed in previous studies, despite pretreatment and poor prognostic factors. These results suggest a potential role for atezolizumab in a broader patient range than typically eligible for phase 1–3 studies.Patient summary
In this expanded access study, atezolizumab was active and tolerable in a range of patients with platinum-treated metastatic urothelial carcinoma. 相似文献9.
David Robinson Hans Garmo Ingela Franck Lissbrant Anders Widmark Andreas Pettersson Adalsteinn Gunnlaugsson Jan Adolfsson Ola Bratt Per Nilsson Pär Stattin 《European urology》2018,73(4):502-511
Background
There are no conclusive results from randomized trials on radiotherapy (RT) versus radical prostatectomy (RP) for prostate cancer. Numerous observational studies have suggested that RP is associated with a lower risk of prostate cancer death, but whether results have been biased due to limited adjustments for confounding factors is unknown.Objective
To compare the risk of prostate cancer death after RT versus RP.Design, setting, and participants
Nationwide population-based observational study of men in the Prostate Cancer data Base Sweden 3.0 who had undergone RT or RP between 1998 and 2012.Outcome measurements and statistical analysis
Prostate cancer deaths were compared. Hazard ratios (HRs) were calculated in Cox regression models, including clinical T stage, M stage, Gleason grade group, serum levels of prostate-specific antigen, proportion of biopsy cores with cancer, mode of detection, comorbidity, age, educational level, and civil status. Period analysis with left truncation was performed.Results and limitations
Primary treatment was RT or RP for 41 503 men. Treatment effect was associated with disease severity. In univariate analysis of RT versus RP, risk of prostate cancer death was higher after RT—low- and intermediate-risk cancer, HR 1.82 (95% confidence interval [CI]: 1.53–2.16), and high-risk cancer, HR 1.57 (95% CI: 1.33–1.85). After full adjustment in period analysis, this difference between the treatments was attenuated—low- and intermediate-risk cancer, HR 1.24 (95% CI: 0.97–1.58), and high-risk cancer, HR 1.03 (95% CI: 0.81–1.31). Confounding remained due to nonrandom allocation to treatment.Conclusions
In comparison with previous studies, the difference in prostate cancer mortality after RT and RP was much smaller.Patient summary
The difference in prostate cancer mortality after contemporary radiotherapy and radical prostatectomy was small in contrast to previous studies, indicating that potential side effects should be more emphasized when selecting treatment. 相似文献10.
Phillip Martin Pierorazio Peter Albers Peter C. Black Torgrim Tandstad Axel Heidenreich Nicola Nicolai Craig Nichols 《European urology》2018,73(6):899-907
Context
Cancer-specific survival for men with clinical stage I testicular cancer (CSITC) is uniformly excellent. Non–risk-adapted active surveillance (NRAS) is a management strategy for CSITC to minimize overtreatment and avoid possible long-term side effects of adjuvant therapy.Objective
To review the evidence regarding oncologic outcomes for men with CSITC undergoing NRAS and discuss ongoing controversies in the management of CSITC.Evidence acquisition
MEDLINE/PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched from January 1, 1987 through January 1, 2017.Evidence synthesis
A total of 68 studies were included in the critical review. The rationale for NRAS, oncologic outcomes, surveillance protocols, and comparative efficacy of risk-adjusted active surveillance (AS) were reported with strength of evidence and risk of bias evaluated. Cancer-specific survival approaches 100% for men with CSITC undergoing NRAS. Active treatment is limited to 20–30% of patients who will recur; these patients will require salvage chemotherapy and possible retroperitoneal lymph node dissection. Existing AS protocols include imaging and laboratory evaluations that are initially intensive but less frequent with increasing follow-up.Conclusions
NRAS is an attractive management option for men with CSITC, which maintains outstanding long-term cancer cure while sparing most patients treatment by avoiding prophylactic chemotherapy, radiation, or surgery.Patient summary
Men with clinically localized (stage I) testicular cancer have an excellent prognosis, regardless of management. Non–risk-adapted active surveillance is an attractive management option where only patients destined to relapse will receive any treatment following orchiectomy. However, individual patient preferences should be discussed in selecting a management strategy. 相似文献11.
Jose Luis Perez-Gracia Yohann Loriot Jonathan E. Rosenberg Thomas Powles Andrea Necchi Syed A. Hussain Rafael Morales-Barrera Margitta M. Retz Günter Niegisch Ignacio Durán Christine Théodore Enrique Grande Xiaodong Shen Jingjing Wang Betty Nelson Christina L. Derleth Michiel S. van der Heijden 《European urology》2018,73(3):462-468
Background
Patients with metastatic urothelial carcinoma (mUC) who progress after platinum-based chemotherapy have had few treatment options and uniformly poor outcomes. Atezolizumab (anti-programmed death-ligand 1) was approved in the USA for cisplatin-ineligible and platinum-treated mUC based on IMvigor210, a phase 2, single-arm, two-cohort study.Objective
To evaluate the efficacy and safety of atezolizumab by the number of prior lines of systemic therapy in patients with pretreated mUC.Design, setting, and participants
IMvigor210 enrolled 315 patients with mUC with progression during or following platinum-based therapy at 70 international sites between May 2014 and November 2014. Key inclusion criteria included age ≥18 yr, creatinine clearance ≥30 ml/min, and Eastern Cooperative Oncology Group performance status 0–1, with no limit on prior lines of treatment.Intervention
Patients in this cohort received atezolizumab 1200 mg intravenously every 3 wk until loss of clinical benefit.Outcome measurements and statistical analysis
Centrally assessed Response Evaluation Criteria In Solid Tumors v1.1 objective response rate (ORR), median duration of response, overall survival (OS), and adverse events were evaluated by prior treatment. Potential differences between subgroups were evaluated using log-rank (for OS) and chi-square (for ORR and adverse events frequencies) testing.Results and limitations
Three hundred and ten patients were efficacy and safety evaluable (median follow-up, 21 mo). Objective responses and prolonged OS occurred across all prespecified subgroups; median duration of response was not reached in most subgroups. In patients without prior systemic mUC therapy (first-line subgroup), ORR was 25% (95% confidence interval: 14–38), and median OS was 9.6 mo (95% confidence interval: 5.9–15.8). No significant differences in efficacy or toxicity by therapy line were observed.Conclusions
Atezolizumab demonstrated comparable efficacy and safety in previously treated patients with mUC across all lines of therapy evaluated.Patient summary
We investigated effects of previous treatment in patients with metastatic urothelial carcinoma that progressed after platinum-based therapy. Atezolizumab was active and tolerable no matter how many treatment regimens patients had received. ClinicalTrials.gov, NCT02108652. 相似文献12.
Jesús Romero-Maroto Lidia Verdú-Verdú Luis Gómez-Pérez Carla Pérez-Tomás Juan-José Pacheco-Bru Ana López-López 《European urology》2018,73(1):123-128
Background
Female urethral stricture is a rare condition. Different types of urethroplasty have been described. However, high quality studies are sparse. The most common technique used—the Blandy's technique—has resulted in our cases in a retrusive meatus and an inward urinary stream.Objective
To show the efficacy and safety of an alternative vaginal wall flap urethroplasty.Design, setting, and participants
A cross-sectional observational study was undertaken in a single University Hospital. Nine female patients previously diagnosed with urethral stricture at our institution underwent open surgery from 1993 to 2015. They were contacted and agreed to undergo a medical examination.Surgical procedure
A ventral lateral-based anterior vaginal wall flap urethroplasty inspired by the Orandi technique for male urethroplasty was performed.Measurements
A chart review was performed.Results and limitations
The mean age was 56 yr (41–78 yr). The mean follow-up was 80.7 mo (12–198). All patients had relief of symptoms. The meatus of all patients stayed in an orthotopic position without any impact on the direction of the urinary stream. The average caliber of the urethra increased from 10.8 Fr (6–18 Fr) to ≥20 Fr. Peak flow improved from a mean of 6.8 ml/s (3–11 ml/s) to 21 ml/s (14–35 ml/s). No patient developed stricture recurrence or de novo stress urinary incontinence. There were no other immediate or delayed complications. All patients achieved a better score on the Patient Global Impression of Improvement questionnaire.Conclusions
Our study, with the same limitations that the few studies published in this field had, that is the few patients included, demonstrates that lateral anterior vaginal wall flap urethroplasty is an effective technique, offering durable results without apparent complications.Patient summary
We studied an alternative surgical technique for the treatment of female urethral stricture. We conclude that it is safe and effective with no apparent complications and good long-term results. 相似文献13.
Rita Faria Marta O. Soares Eldon Spackman Hashim U. Ahmed Louise C. Brown Richard Kaplan Mark Emberton Mark J. Sculpher 《European urology》2018,73(1):23-30
Background
The current recommendation of using transrectal ultrasound-guided biopsy (TRUSB) to diagnose prostate cancer misses clinically significant (CS) cancers. More sensitive biopsies (eg, template prostate mapping biopsy [TPMB]) are too resource intensive for routine use, and there is little evidence on multiparametric magnetic resonance imaging (MPMRI).Objective
To identify the most effective and cost-effective way of using these tests to detect CS prostate cancer.Design, setting, and participants
Cost-effectiveness modelling of health outcomes and costs of men referred to secondary care with a suspicion of prostate cancer prior to any biopsy in the UK National Health Service using information from the diagnostic Prostate MR Imaging Study (PROMIS).Intervention
Combinations of MPMRI, TRUSB, and TPMB, using different definitions and diagnostic cut-offs for CS cancer.Outcome measurements and statistical analysis
Strategies that detect the most CS cancers given testing costs, and incremental cost-effectiveness ratios (ICERs) in quality-adjusted life years (QALYs) given long-term costs.Results and limitations
The use of MPMRI first and then up to two MRI-targeted TRUSBs detects more CS cancers per pound spent than a strategy using TRUSB first (sensitivity = 0.95 [95% confidence interval {CI} 0.92–0.98] vs 0.91 [95% CI 0.86–0.94]) and is cost effective (ICER = £7,076 [€8350/QALY gained]). The limitations stem from the evidence base in the accuracy of MRI-targeted biopsy and the long-term outcomes of men with CS prostate cancer.Conclusions
An MPMRI-first strategy is effective and cost effective for the diagnosis of CS prostate cancer. These findings are sensitive to the test costs, sensitivity of MRI-targeted TRUSB, and long-term outcomes of men with cancer, which warrant more empirical research. This analysis can inform the development of clinical guidelines.Patient summary
We found that, under certain assumptions, the use of multiparametric magnetic resonance imaging first and then up to two transrectal ultrasound-guided biopsy is better than the current clinical standard and is good value for money. 相似文献14.
Leilei Xu Jin Zhou Zhou Wang Jin Xiong Yong Qiu Shoufeng Wang 《Foot and Ankle Surgery》2018,24(2):149-153
Background
To investigate the effectiveness of tibiotalocalcaneal arthrodesis with a retrograde nail and allograft in limb salvage surgery for patients with distal tibia osteosarcoma.Methods
5 patients diagnosed as distal tibia osteosarcoma underwent ankle arthrodesis with a retrograde nail in our hospital. During the follow-up, radiographic views of the ankle joint were taken in two planes to assess bone healing and axis alignment. Other measurements of outcomes included procedure-related complications, local recurrence, and metastasis. Functional outcomes were evaluated with the Musculoskeletal Tumor Society (MSTS) scoring system.Results
Postoperative complications occurred in 4 patients, including 4 cases of mild subcutaneous fluid and 1 case of screw breakage. All patients showed stable ankle and could stand or walk with the assistance of crutch before the complete union between allograft and host bone. One patient died due to multiple bone and pulmonary metastasis at 1 year after surgery. As for the other 4 patients, they were followed-up regularly for a mean period of 42 months. No local recurrence or distant metastasis occurred in any of these four patients. All the 4 patients expressed satisfaction with the outcome. According to MSTS scale, the mean postoperative functional score was 74.3% ± 4.4% (range, 70%–81%).Conclusions
Intramedullary retrograde nail for distal tibia osteosarcoma could produce a satisfactory outcome in terms of functional results and complications. Excellent stabilization of the ankle joint can be achieved through this technique, as it allows patients to perform much earlier postoperative weight-bearing exercise. 相似文献15.
16.
Sherif Dabash Gautham Prabhakar Eric Potter Ahmed M. Thabet Amr Abdelgawad Stephen Heinrich 《Journal of Clinical Orthopaedics and Trauma》2018
Introduction
Premature growth arrest can pose a challenge to the orthopedic surgeon. Various options for treating physeal arrest exist.Methods
Systematic searches were conducted on PubMed/Medline, ScienceDirect, OVID, and Cochrane Library. Secondary searching was performed, where certain articles from reference lists of the selected studies were reviewed that were not found in the primary search.Results
This review article discusses the different methods of management for premature growth arrest.Conclusions
The use of mesenchymal stem cells provides a promising alternative treatment modality. 相似文献17.
Background
There is an evident lack of research on timing of polydactyly surgery and its effects on treatment results.Methods
Retrospective comparative study on foot polydactyly patients treated at our department from 1995 to 2009. Patients were divided into 2 groups, group A – under the age of 5 at surgery, and group B – 5 years and older.Results
There were 24 patients (8 male, 16 female), 30 feet. Median age at surgery was 1 year (range, 9 months–4.5 years) for group A, and 8.5 years (range, 6–37 years) for group B. Median follow-up was 16.2 years (range, 7–21 years). There were 16 postaxial and 8 preaxial cases. At the last follow-up 12 patients’ feet were “excellent” and 12 “good”. No significant differences were identified between the two groups at final follow-up.Conclusions
Timing of surgery for foot polydactyly is not crucial for final results. 相似文献18.
Boris Gershman Daniel M. Moreira R. Houston Thompson Stephen A. Boorjian Christine M. Lohse Brian A. Costello John C. Cheville Bradley C. Leibovich 《European urology》2018,73(3):469-475
Background
There are little data regarding the morbidity of lymph node dissection (LND) for renal cell carcinoma (RCC) to assess its risk–benefit ratio.Objective
To evaluate the association of LND with 30-d complications among patients undergoing radical nephrectomy (RN) for RCC.Design, setting, and participants
A total of 2066 patients underwent RN for M0 or M1 RCC between 1990 and 2010, of whom 774 (37%) underwent LND.Intervention
RN with or without LND.Outcome measurements and statistical analysis
Associations of LND with 30-d complications were examined using logistic regression with several propensity score techniques. Extended LND, defined as removal of ≥13 lymph nodes, was examined in a sensitivity analysis.Results and limitations
A total of 184 (9%) patients were pN1 and 302 (15%) were M1. Thirty-day complications occurred in 194 (9%) patients, including Clavien grade ≥3 complications in 81 (4%) patients. Clinicopathologic features were well balanced after propensity score adjustment. In the overall cohort, LND was not statistically significantly associated with Clavien grade ≥3 complications, although there was an approximately 40% increased risk of any Clavien grade complication that did not reach statistical significance. Likewise, LND was not significantly associated with any Clavien grade or Clavien grade ≥3 complications when separately evaluated among M0 or M1 patients. Extended LND was not significantly associated with any Clavien grade or Clavien grade ≥3 complications. LND was not associated with length of stay or estimated blood loss. Limitations include a retrospective design.Conclusions
LND is not significantly associated with an increased risk of Clavien grade ≥3 complications, although it may be associated with a modestly increased risk of minor complications. In the absence of increased morbidity, LND may be justified in a predominantly staging role in the management of RCC.Patient summary
Lymph node dissection for renal cell carcinoma is not associated with increased rates of major complications. 相似文献19.
Giuseppe Simone Rocco Papalia Leonardo Misuraca Gabriele Tuderti Francesco Minisola Mariaconsiglia Ferriero Giulio Vallati Salvatore Guaglianone Michele Gallucci 《European urology》2018,73(6):934-940
Background
Robot-assisted radical cystectomy (RARC) with intracorporeal neobladder reconstruction is a challenging procedure. The need for surgical skills and the long operative times have led to concern about its reproducibility.Objective
To illustrate our technique for RARC and totally intracorporeal orthotopic Padua ileal bladder.Design, setting, and participants
From August 2012 to February 2014, 45 patients underwent this technique at a single tertiary referral centre.Surgical procedure
RARC, extended pelvic lymph node dissection, and intracorporeal partly stapled neobladder. Surgical steps are demonstrated in the accompanying video.Measurements
Demographics, clinical, and pathological data were collected. Perioperative, 2-yr oncologic and 2-yr functional outcomes were reported.Results and limitations
Intraoperative transfusion or conversion to open surgery was not necessary in any case and intracorporeal neobladder was successfully performed in all 45 patients. Median operative time was 305 min (interquartile range [IQR]: 282–345). Median estimated blood loss was 210 ml (IQR: 50–250). Median hospital stay was 9 d (IQR: 7–12). The overall incidence of perioperative, 30-d and 180-d complications were 44.4%, 57.8%, and 77.8%, respectively, while severe complications occurred in17.8%, 17.8%, and 35.5%, respectively. Two-yr daytime and night-time continence rates were 73.3% and 55.5%, respectively. Two-yr disease free survival, cancer specific survival, and overall survival rates were 72.5%, 82.3%, and 82.4%, respectively. The small sample size and high caseload of the centre might affect the reproducibility of these results.Conclusions
Our experience supports the feasibility of totally intracorporeal neobladder following RARC. Operative times and perioperative complication rates are likely to be reduced with increasing experience.Patient summary
We report the outcomes of our first 45 consecutive patients who underwent robot-assisted radical cystectomy with intracorporeal neobladders. Perioperative, oncologic, and functional outcomes support this technique as a feasible and safe surgical option in tertiary referral centres. 相似文献20.
Ian D. Davis Wanling Xie Carmel Pezaro Frede Donskov J. Connor Wells Neeraj Agarwal Sandy Srinivas Takeshi Yuasa Benoit Beuselinck Lori A. Wood D. Scott Ernst Ravindran Kanesvaran Jennifer J. Knox Allan Pantuck Sadia Saleem Ajjai Alva Brian I. Rini Jae-Lyun Lee Daniel Y.C. Heng 《European urology》2017,71(6):970-978