Predictors for immediate recovery of continence following Retzius-sparing robot-assisted radical prostatectomy: a case–control study

International Urology and Nephrology - We evaluated urinary continence in a series of consecutive patients who underwent Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) to identify...     

Dislocation of hip hemiarthroplasty following posterolateral surgical approach: a nested case–control study

Purpose  

Hip hemiarthroplasty dislocation is a serious complication in treatment of displaced intracapsular hip fractures. We investigated factors associated with an increased risk of dislocation after cemented hip hemiarthroplasty following the posterolateral approach.     

Dietary habits and prostate cancer detection: a case–control study

Background

Many studies have suggested that nutritional factors may affect prostate cancer development. The aim of our study was to evaluate the relationship between dietary habits and prostate cancer detection.

Methods

We studied 917 patients who planned to have transrectal ultrasonography–guided prostatic biopsy based on an elevated serum prostate-specific antigen (PSA) level, a rising serum PSA level or an abnormal digital rectal examination. Before receiving the results of their biopsy, all patients answered a self-administered food frequency questionnaire. In combination with pathology data we performed univariable and multivariable logistic regression analyses for the predictors of cancer and its aggressiveness.

Results

Prostate cancer was found in 42% (386/917) of patients. The mean patient age was 64.5 (standard deviation [SD] 8.3) years and the mean serum PSA level for prostate cancer and benign cases, respectively, was 13.4 (SD 28.2) μg/L and 7.3 (SD 4.9) μg/L. Multivariable analysis revealed that a meat diet (e.g., red meat, ham, sausages) was associated with an increased risk of prostate cancer (odds ratio [OR] 2.91, 95% confidence interval [CI] 1.55–4.87, p = 0.027) and a fish diet was associated with less prostate cancer (OR 0.54, 95% CI 0.32–0.89, p = 0.017). Aggressive tumours were defined by Gleason score (≥ 7), serum PSA level (≥ 10 μg/L) and the number of positive cancer cores (≥ 3). None of the tested dietary components were found to be associated with prostate cancer aggressivity.

Conclusion

Fish diets appear to be associated with less risk of prostate cancer detection, and meat diets appear to be associated with a 3-fold increased risk of prostate cancer. These observations add to the growing body of evidence suggesting a relationship between diet and prostate cancer risk.     

Laparoscopic surgery for the curative treatment of rectal cancer: results of a Chinese three-center case–control study

Background  This study aimed to assess the efficacy and safety of laparoscopic resection (LR) for rectal cancer. Methods  A case-control study involving three Chinese medical centers was conducted. Rectal cancer patients undergoing LR were compared with open resection (OR) cases simultaneously from January 2004 to December 2005. Data were collected, and basic characteristics, conversion rate, recovery, complications, adjuvant therapy, and recurrence rate were compared. Analysis was by intention to treat. Results  A total of 335 rectal cancer procedures (115 LR and 220 OR) met the inclusion criteria. The patients’ basic characteristics were similar in the two groups (p > 0.05). Total mesorectal excision was performed for 85.59% of the patients (201/235), who received anal sphincter preservation. Compared with OR, LR had a shorter incision length, less blood loss, and less need for transfusion, but the operation time was longer (p < 0.05). No significant differences were observed between the two groups in positive rates of longitudinal resection margins, numbers of harvested lymph nodes, complication rates during operation and postoperation, and perioperative reoperation and morbidity rates (p > 0.05). Postoperative parenteral narcotics were used less in LR than in OR (47.8% vs 62.7%; χ² = 6.867; p = 0.009). The median time until first flatus; resumption of diet, defecation, micturition, and ambulation; and discharge were reduced in LR (p < 0.05). Conversion from LR to OR was required by 11.3% of the patients (13/115). The intraoperative complication rate was 30.8% for the patients who underwent conversion. The operation time and postoperative complication rate were the same as for LR alone (p > 0.05). The local recurrence rate was 3.7% for the LR group and 4.9% for the OR group (χ ² = 0.209; p = 0.647) during the 20-month median follow-up period. Conclusions  The findings showed that LR for rectal cancer was safe and effective, resulting in faster recovery and a similar complication rate compared with OR. Conversion did not alter the patients’ outcomes.     

Laparoscopic versus open distal gastrectomy for locally advanced gastric cancer: a case–control study

In a non-specialized setting, laparoscopic distal gastrectomy (LDG) for locally advanced diseases remains controversial, particularly given to the technical demands of the learning curve required to perform an adequate resection with D2 lymph node dissection. Inclusion criteria for this statistically generated matching controlled study were all patients who underwent subtotal laparoscopic gastrectomies from January 2006 until September 2009 for locally advanced gastric adenocarcinoma (stage II–IIIb), compared with matched patients who underwent the same procedure in an open fashion during the same period. Sixty case-matched patients were evaluated (30 laparoscopic vs. 30 open). Operative time was significantly longer (p < 0.05) for LDG. Benefits for LDG (p < 0.05) were observed among surgical short-term outcome (postoperative hospital stay, ambulation, first bowel movement, first flatus, first stool, first eating and use of analgesic drugs) and postoperative non-surgical site complications (cardiopulmonary, urinary, etc.). The 42 months’ overall survival was similar (p = 0.646). Laparoscopic gastrectomy is a safe technique in a non-academic hospital setting for locally advanced gastric cancer; it seems to be adequate in terms of margin status and adequate lymph node retrieval and is associated with additional benefits as a decreased length of hospital stay, a decreased narcotic use and fewer complications.     

No differences in short-term morbidity and mortality after robot-assisted laparoscopic versus laparoscopic resection for colonic cancer: a case–control study of 263 patients

Background

Robot-assisted laparoscopy has been reported to be a safe and feasible alternative to traditional laparoscopy. The aim of this study was to compare short-term results in patients with colonic cancer who underwent robot-assisted laparoscopic colonic resection (RC) or laparoscopic colonic resection (LC).

Methods

The study was a retrospective case control study of all patients with colonic cancer who underwent RC from March 2010 to March 2012 or LC from January 2009 to December 2011 at a tertiary-care university hospital. Data were retrieved from the national chart database and patient journals. Biochemical markers [C-reactive protein (CRP), hemoglobin, white blood cell count, and thrombocyte count] were recorded before surgery and for the first 3 days after surgery.

Results

A total of 101 patients underwent RC and 162 patients underwent LC. There were no significant differences in the rate of conversion to open surgery, number of permanent enterostomies, number of intraoperative complications, level of postoperative cellular stress response, number of postoperative complications, length of postoperative hospital stay, or 30-day mortality between the two groups. There was a significantly longer setup time for RC (77.1 vs. 69.7 min, P = 0.000), but surgical time was significantly shorter for RC (165.8 vs. 183.4 min, P = 0.006) and there was no difference in the overall procedure time (254.0 vs. 243.6 min, P = 0.086).

Conclusion

We found RC to be a safe and feasible alternative to LC for colonic cancer. We found that for RC surgical time was shorter and overall procedure time was comparable to that for LC; however, these results should be confirmed in future randomized clinical trials.     

Quality of care: partial cystectomy for bladder cancer--a case of inappropriate use?

PURPOSE: Partial cystectomy is perceived to be a less morbid, less technically demanding procedure than radical cystectomy, although only select patients (approximately 6% to 10%) are appropriate candidates (solitary tumor in space/time, absence of carcinoma in situ). From a quality of care perspective, overuse of partial cystectomy may signify inappropriate delivery of health care. MATERIALS AND METHODS: Subjects who underwent extirpative treatment for bladder cancer between 1988 and 2000 were identified within the Surveillance, Epidemiology and End Results (SEER, 3,381) registry and the Nationwide Inpatient Sample (NIS, 22,088). Adjusted models were developed to identify clinical factors independently associated with the use of partial cystectomy for bladder cancer treatment within each sample. RESULTS: Among patients who underwent extirpative surgery for bladder cancer, 18% and 20% of those in SEER and NIS, respectively, underwent partial cystectomy. Significant decreases in use between early and later years were noted in both samples (SEER-22% to 13%, NIS-24% to 17%, both p <0.0001). Partial cystectomy was preferentially used in the elderly, those with stage I disease, females and black patients. Furthermore, partial cystectomy was more commonly provided in rural, nonteaching, low volume hospitals. CONCLUSIONS: Trends in national use of partial cystectomy are consistent between the NIS and SEER with 13% to 17% of patients currently being treated with partial in lieu of radical cystectomy. Partial cystectomy is disproportionately used in certain medical centers (nonteaching, rural, low volume) and patient populations (elderly, black, females, stage I disease) reflecting selective referral or overuse.     

Totally laparoscopic versus laparoscopy-assisted Billroth-I anastomosis for gastric cancer: a case–control and case-matched study

Objective

To evaluate the safety, feasibility and clinical results of the modified delta-shaped gastroduodenostomy (MDSG) in totally laparoscopic distal gastrectomy (TLDG) for gastric cancer (GC).

Methods

We performed a case–control and case-matched study enrolling 642 patients with GC undergoing laparoscopic distal gastrectomy with Billroth-I anastomosis from January 2011 to December 2014. TLDG with MDSG was performed in 158 patients (Group TL), and laparoscopy-assisted distal gastrectomy with circular anastomosis was performed in 484 patients (Group LA). One-to-one propensity score matching (PSM) was performed to compare the clinicopathological characteristics between the two groups.

Results

Patients with smaller tumors or stage I cancer were more likely to receive TLDG (P < 0.05). In the propensity-matched analysis of 143 pairs, there were no differences in demographic and pathologic characteristics between groups (all P < 0.05). All patients successfully underwent laparoscopic radical distal gastrectomy. Before PSM, Group TL had more dissected lymph nodes (LNs), a longer time to first fluid diet and a longer postoperative length of stay than Group LA (all P < 0.05). After PSM, except for the fact that more dissected LNs were obtained in Group LA (P < 0.05), no difference was found in the intraoperative and postoperative outcomes between the groups (all P > 0.05). The postoperative complications were similar in both groups (all P > 0.05). Stratification analysis performed after PSM showed that in early GC, no difference was observed in intraoperative and postoperative outcomes between the groups (all P > 0.05). However, in locally advanced GC, Group TL had more dissected LNs and a higher rate of postoperative complications (both P < 0.05). Univariate analysis carried out in locally advanced cases after PSM showed that the body mass index (BMI), the method of digestive tract reconstruction and Charlson’s score were significant factors that affected postoperative morbidity (all P < 0.05). Multivariate analysis indicated that BMI was an independent risk factor for postoperative morbidity (P < 0.05).

Conclusions

The MDSG in TLDG is safe and feasible for early GC; however, it should be chosen with caution in advanced GC, particularly in patients with a high BMI.

     

Systemic inflammatory response after laparoscopic and conventional colectomy for cancer: a matched case–control study

Background

Studies dealing with laparoscopic colectomy for cancer have reached conflicting results in regards to various inflammatory cytokines. Most of them have not examined potential differences with the open procedures at later postoperative days, when the immunologic advantage of laparoscopic surgery would be more demanding to demonstrate (for earlier administration of adjuvant treatment). The aim of this work is to detect differences of proinflammatory cytokines between conventional and laparoscopic colectomy for cancer.

Patients and methods

30 patients who underwent laparoscopic colectomy were age, sex, and preoperative stage-matched with 30 patients treated by open surgery. C-reactive protein (CRP), interleukin (IL)-1, -6, and -8, and interferon (IFN)-γ serum levels were measured preoperatively, at 24 h, and at the 7th postoperative day (POD).

Results

CRP and IL-6 postoperative values (24 h and 7th POD) were significantly higher than baseline for both groups (p = 0.001), but the respective values at the 7th POD were less than at 24 h (p = 0.001). IL-1 and -8 levels did not show any differences between assessment timepoints. A higher IFN-γ measurement was demonstrated at 24 h compared with baseline for the laparoscopic group only (p = 0.03). This difference was not maintained at the 7th POD. IFN-γ levels at 24 h and the 7th POD were significantly less for the open compared with the laparoscopic group of patients (p = 0.001). No correlation was revealed between measured serum values and age, sex, tumor location, or stage.

Conclusions

This matched case–control study verifies the already reported lack of differences regarding IL-1. Controversy still exists on likely IL-6 differences. The inadequately studied IL-8 does not seem to play an important role in immunologic differences. The immunologically beneficial IFN-γ, produced by the principal effectors of cell-mediated immunity Th1 cells, seems to have a more active presence following laparoscopic colectomy, potentially contributing to an immunologic “advantage” by counteracting “harmful” cytokines, such as IL-1.

     

Factors affecting fetal bradycardia following combined spinal epidural for labor analgesia: a matched case–control study

Purpose

The combined spinal epidural (CSE) technique for labor analgesia has become increasingly popular owing to its rapid onset of analgesia. However, incidences of fetal bradycardia following CSE have been reported. This study aimed to identify predictors of fetal bradycardia post CSE, such as a decrease in pain scores, the block height, Prostin (dinoprostone; Pfizer) use, and dosage of oxytocin.

Methods

From May 2008 to October 2008, 29 patients were identified to have had an episode of fetal bradycardia. Each case was then matched to three controls, according to age and American Society of Anesthesiology status, selected from 2345 parturients who received a CSE during this period.

Results

A unit improvement in the pain score was associated with an increase in the odds of fetal bradycardia by 1.28 (95 % confidence interval [CI]: 1.02–1.60). In a second logistic regression model including sensory level higher than T9, the effect size remained consistent with an odds ratio of 1.22 (95 % CI: 0.97–1.53), supporting the theory that a higher level of sympathetic block (with a higher sensory block taken as a surrogate marker) results in an increased risk of fetal bradycardia. The dosage of oxytocin and the quantity of Prostin used were not found to be risk factors.

Conclusion

The difference between pre- and post-CSE pain scores, and a higher sensory block height, which are surrogates for a greater degree of sympatholysis, were found to be risk factors for fetal bradycardia post CSE.     

Impact of bladder neck involvement on progression in patients with primary non–muscle invasive bladder cancer: A prospective validation study

PurposeOur previous retrospective study reported that bladder neck involvement (BNI), as well as tumor grade and stage, was a significant risk factor for progression in primary non–muscle invasive bladder cancer (NMIBC). We prospectively validated BNI as a significant predictor for progression using a new cohort of patients with primary NMIBC.Patients and methodsA total of 297 new Japanese patients who underwent transurethral resection and were pathologically diagnosed with Ta or T1 urothelial carcinoma were enrolled in this prospective study. Clinicopathologic data were collected at study entry. Multivariate Cox proportional hazards regression models were performed to identify the independent predictors for progression. A predictive scoring model for progression was developed using the regression coefficients (RCs) from the final multivariate model. The predictive ability of the model was assessed using Harrell's c-index.ResultsWith a median follow-up of 37 months, 16 patients (5.4%) progressed. Progression probability at 1 and 5 years were 1.5% and 8.0%, respectively. Multivariate analysis revealed that histologic grade 3 (hazard ratio [HR] 9.45, P = 0.0004, RC 2.25), pathologic T1 stage (HR 6.91, P = 0.0014, RC 1.93), and BNI (HR 11.75, P = 0.0009, RC 2.46) were all independent predictors of progression. When all 3 variables were scored as 1 point and the patients were divided into 3 groups, progression rates were clearly discriminated (P<0.0001). The c-index was 0.80.ConclusionsThis prospective validation study has shown that BNI is a significant prognostic factor for progression in primary NMIBC. The scoring model including BNI enables the physician to classify patients with primary NMIBC into 3 groups with clearly different progression rates.     

Risk factors for hospital-acquired urinary tract infection: a case–control study

The objective is to assess risk factors and microbiological aspects of hospital-acquired urinary tract infection (HAUTI) on six wards of a general regional hospital in Serbia. A case–control study was nested within prospective cohort HAUTIs study conducted from January 1 to December 31, 2007. Three controls were identified for each patient with HAUTI, being chronologically the next three patients surveyed who did not develop HAUTI. The patients and controls were matched by sex and age (±5 years). Assessment of 8,467 patients during the study period revealed HAUTI in 125 (116 symptomatic and 9 asymptomatic). The overall incidence rate of HAUTI was 14.8 cases/1,000 admissions. The mean age (range) of cases and controls was 64.9 (18–85) and 65.2 (17–86), respectively. Multivariate logistic regression analysis showed that duration of catheterization >5 days (OR = 51.91; 95% CI = 23.46–114.82) and the ASA score (OR = 13.42; 95% CI = 2.14–84.30) were independently associated with increased risk of HAUTIs. The most frequently isolated Gram-negative bacteria were Enterobacter, Klebsiella sp., Proteus mirabilis and Escherichia coli. Enterococcus sp. was the most frequent Gram-positive bacteria.     

Perioperative outcomes of surgical procedures for symptomatic fundoplication failure: a retrospective case–control study

Background  

Anatomic failure with recurrent gastroesophageal reflux disease (GERD) or related symptoms following fundoplication is a well-described occurrence. Occasionally, reoperative surgery is required. The morbidity of revisional surgery can be quite high, and the clinical outcomes may not be as good as is observed following primary antireflux operations.