You have accessJournal of UrologyKidney Cancer: Advanced (II)1 Apr 20131906 PREOPERATIVE PULMONARY EMBOLISM DOES NOT PREDICT POOR POSTSURGICAL OUTCOMES IN RCC PATIENTS WITH VENOUS THROMBUS E. Jason Abel, Christopher G. Wood, Nathan Eickstaedt, Justin E. Fang, Patrick Kenney, Aditya Bagrodia, Daniel Ramirez, Bishoy A. Gayed, Tracy M. Downs, Ramy F Youssef, Christopher Odom, Arthur Sagalowsky, and Vitaly Margulis E. Jason AbelE. Jason Abel Madison, WI More articles by this author , Christopher G. WoodChristopher G. Wood Houston, TX More articles by this author , Nathan EickstaedtNathan Eickstaedt Madison, WI More articles by this author , Justin E. FangJustin E. Fang Houston, TX More articles by this author , Patrick KenneyPatrick Kenney Houston, TX More articles by this author , Aditya BagrodiaAditya Bagrodia Dallas, TX More articles by this author , Daniel RamirezDaniel Ramirez Dallas, TX More articles by this author , Bishoy A. GayedBishoy A. Gayed Dallas, TX More articles by this author , Tracy M. DownsTracy M. Downs Madison, WI More articles by this author , Ramy F YoussefRamy F Youssef Dallas, TX More articles by this author , Christopher OdomChristopher Odom Dallas, TX More articles by this author , Arthur SagalowskyArthur Sagalowsky Dallas, TX More articles by this author , and Vitaly MargulisVitaly Margulis Dallas, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2325AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Renal cell carcinoma (RCC) patients who present with pulmonary embolism (PE) and venous thrombus may not be offered surgery because of concerns with anti-coagulation and presumed poor post-surgical outcomes. The objective of this study was to evaluate post- surgical recurrence and cancer specific survival in RCC patients with venous thrombus who had PE diagnosed at initial presentation. METHODS After IRB approval, we reviewed the records from 2000-2011 at 3 tertiary hospitals (UW, UTMDACC, UTSW) for all consecutive RCC patients who had nephrectomy with thrombectomy. Clinical and pathologic predictive factors for recurrence and survival were collected for each patient. Univariate and multivariate analysis was used to evaluate whether PE at presentation was associated with RCC recurrence or survival after nephrectomy with thrombectomy. RESULTS Preoperative PE was diagnosed in 35/782 (4.4%) RCC patients undergoing nephrectomy with thrombectomy with a median follow-up time of 22 months. Patients with PE at initial diagnosis were more likely to have higher level thrombus (p<0.01) but no differences were found between groups for age, gender, race, tumor diameter, Fuhrman grade, sarcomatoid de-differentiation, peri-nephric fat invasion or histologic subtype. In N0M0 patients, there was no difference (p=0.36) in the rate of RCC recurrence for 395/782(50%) or 7/17(41%) patients without PE or with PE respectively. On multivariate analysis, peri-nephric fat invasion, Fuhrman grade, and thrombus height, but not preoperative PE status, were predictive of recurrence risk. Similarly, there was no difference in the rates of lung metastases for 67/123 (53%) N0M0 patients without PE or 3/7 (43%) patients with PE (p=0.71). Preoperative PE diagnosis was not predictive of death from RCC (p=0.58). On multivariate analysis, presence of metastatic disease, peri-nephric fat invasion, sarcomatoid de-differentiation, Fuhrman grade 4, and tumor diameter were independently predictive of risk of death from RCC. CONCLUSIONS PE at initial diagnosis is not associated with worse post-surgical recurrence or survival in RCC patients with tumor thrombus. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e781 Peer Review Report Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information E. Jason Abel Madison, WI More articles by this author Christopher G. Wood Houston, TX More articles by this author Nathan Eickstaedt Madison, WI More articles by this author Justin E. Fang Houston, TX More articles by this author Patrick Kenney Houston, TX More articles by this author Aditya Bagrodia Dallas, TX More articles by this author Daniel Ramirez Dallas, TX More articles by this author Bishoy A. Gayed Dallas, TX More articles by this author Tracy M. Downs Madison, WI More articles by this author Ramy F Youssef Dallas, TX More articles by this author Christopher Odom Dallas, TX More articles by this author Arthur Sagalowsky Dallas, TX More articles by this author Vitaly Margulis Dallas, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

433 Background: Renal cell carcinoma (RCC) patients who present with pulmonary embolism (PE) and venous thrombus may not be offered surgery because of concerns with anti-coagulation and presumed poor post-surgical outcomes. The objective of this study was to evaluate post-surgical recurrence and disease specific survival (DSS) in RCC patients with venous thrombus who had PE diagnosed at initial presentation. Methods: After IRB approval, we reviewed the records from 2000-2011 at 3 tertiary hospitals (UW, UTMDACC, UTSW) for all consecutive RCC patients who had nephrectomy with thrombectomy. Clinical and pathologic predictive factors for recurrence and survival were collected for each patient. Univariate and multivariate analysis was used to evaluate whether PE at presentation was associated with RCC recurrence or DSS after nephrectomy with thrombectomy. Results: Preoperative PE was diagnosed in 35/782 (0.5%) RCC patients undergoing nephrectomy with thrombectomy with a median follow-up time of 22 months. Patients with PE at initial diagnosis were more likely to have higher level thrombus (p<0.01) but no differences were found between groups for age, gender, race, tumor diameter, Fuhrman grade, sarcomatoid de-differentiation, peri-nephric fat invasion or histologic subtype. In N0M0 patients, there was no difference (p=0.36) in the rate of RCC recurrence for 395/782(50%) or 7/17(41%) patients without PE or with PE respectively. On multivariate analysis, peri-nephric fat invasion, Fuhrman grade, and thrombus height, but not preoperative PE status, were predictive of recurrence risk. Similarly, there was no difference in the rates of lung metastases for 67/123 (53%) N0M0 patients without PE or 3/7 (43%) patients with PE (p=0.71). Preoperative PE diagnosis was not predictive of death from RCC (p=0.58). On multivariate analysis, peri-nephric fat invasion, sarcomatoid de-differentiation, Fuhrman grade, and thrombus height, were independently predictive of risk of death from RCC. Conclusions: PE at initial diagnosis is not associated with worse post-surgical recurrence or survival in RCC patients with tumor thrombus.

Background: Conventional laparoscopic nephrectomy (LN) is the gold standard approach for nephrectomy. An advance in minimally invasive nephrectomy is laparoendoscopic single-site nephrectomy (LESS-N).Objective: To compare 5-yr experience and outcomes of LESS-N to LN.Design, setting, and participants: Retrospective, case-control, single-surgeon series of 47 LESS-N cases matched in a 1: 2 fashion by age, indication, and tumor size to 94 LN controls. LESS-N procedures were performed between August 2007 and February 2012 and LN procedures between December 1999 and 2009.Intervention: LESS-N or LN.Outcome measurements and statistical analysis: Categorical variables were compared by chi(2) analysis, and continuous variables were compared using the Mann-Whitney test.Results and limitations: There were significantly more female patients (66% vs 46%; p = 0.023) and a significantly lower median body mass index (24 kg/m(2) vs 28 kg/m(2); p < 0.001) in the LESS-N group compared with the LN group. Surgical indication was benign in 69 patients (23 LESS-N and 46 LN) and malignant in 72 patients (24 LESS-N and 48 LN). There were no significant differences for the LESS-N and LN groups, respectively, in mean operative time (149 min vs 150 min; p = 0.9), change in hematocrit (5.6% vs 4.8%; p = 0.661), change in creatinine (0.18 mg/dl vs 0.49 mg/dl; p = 0.18), analgesic use (morphine equivalents) (18.4 vs 17.5; p = 0.81), or intraoperative complication rates (6.4% vs 2.1%; p = 0.20). Length of stay was shorter (49 h vs 70 h; p = 0.017) and estimated blood loss was lower (56 ml vs 137 ml; p = 0.002) for the LESS-N group. Over a mean follow-up of 3 yr, postoperative complications (12.8% vs 7.4%; p = 0.30), disease-free survival (95.8% vs 87.5%; p = 0.384), and overall survival (91.7% vs 95.8%; p = 0.123) were not significantly different. The most significant limitation of this study is the retrospective design.Conclusions: This series demonstrates that LESS-N is safe and durable in properly selected patients; however, multi-institutional randomized trials are required to confirm benefits. (C) 2013 European Association of Urology. Published by Elsevier B. V. All rights reserved.

You have accessJournal of UrologyTechnology & Instruments: Laparoscopy: Malignant & Benign Disease1 Apr 2013835 FIVE YEAR EXPERIENCE WITH LAPAROENDOSCOPIC SINGLE-SITE (LESS) NEPHRECTOMY Aditya Bagrodia, Christopher Odom, Jodi Antonelli, and Jeffrey Cadeddu Aditya BagrodiaAditya Bagrodia Dallas, TX More articles by this author , Christopher OdomChristopher Odom Dallas, TX More articles by this author , Jodi AntonelliJodi Antonelli Dallas, TX More articles by this author , and Jeffrey CadedduJeffrey Cadeddu Dallas, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.402AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In 2007, Laparoendoscopic Single-Site (LESS) nephrectomy was the first urologic LESS operation reported. The literature is abound with feasibility studies and short-term outcomes for patients receiving a variety of LESS procedures. Herein, we report our five year experience with LESS nephrectomy compared to conventional laparoscopic nephrectomy (CL). METHODS This is a retrospective, case-control, single-surgeon series of 47 LESS nephrectomies (cases) matched to 94 conventional laparoscopic nephrectomies (controls) in a 1:2 fashion. The LESS nephrectomy cases were performed between August 2007 and August 2012 while the 94 CL nephrectomies were completed between December 1999 and December 2009. Controls were acquired from an institutional database of laparoscopic nephrectomies. Age, surgical indication, and tumor size were employed for matching parameters. Charts were reviewed and critical data was acquisitioned for comparison. Categorical variables were compared via chi-squared analysis and continuous variables with Mann-Whitney test. RESULTS Mean age (years) was comparable between groups (53 CL vs 50 LESS, p=0.4) There were significantly more females in the LESS cohort (66% vs 46%, p=.02) Surgical indication was nonfunctioning kidney in 69 patients (23 LESS and 46 CL) and enhancing mass in 72 patients (24 LESS and 48 CL). There were no significant differences in median operative time (135 min vs 135 min, p=0.9), incision length (39 mm vs 60 mm, p=0.18), change in hematocrit (5.8 vs 4.9, p=0.67), change in creatinine (0.12 vs 0.15, p=0.18), analgesic use (18.4 morphine equivalents vs 17.5 morphine equivalents, p=0.86), or intraoperative complications (6.4% vs 2.1%, p=0.20) for LESS and CL, respectively. Length of stay (hours) was shorter for the LESS cohort (49 vs 52, p=0.02). Over a mean follow up of 35 months, no differences were noted in the rate of late (>4 weeks) complications (12.8% vs 7.4%, p=0.46) or events of distant recurrence (2.1% vs 5.4%, p=0.39) for patients receiving LESS and CL nephrectomy, respectively. There were no local recurrences in either cohort. CONCLUSIONS Our study demonstrates that LESS nephrectomy is safe and provides durable outcomes in properly selected patients though beyond cosmesis LESS may not be overtly advantageous over conventional laparoscopic nephrectomy. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e342-e343 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aditya Bagrodia Dallas, TX More articles by this author Christopher Odom Dallas, TX More articles by this author Jodi Antonelli Dallas, TX More articles by this author Jeffrey Cadeddu Dallas, TX More articles by this author Expand All Advertisement Advertisement Loading ...

BACKGROUND AND PURPOSE The development of effective preventive therapy for renal calculi in patients with secondary hyperoxaluria (2°HO) relies on establishing the pattern of normal variation in urinary oxalate (uOx) and attempting to reduce it. Therefore, we evaluated uOx at baseline and at subsequent time points in stone formers with 2°HO. METHODS We reviewed the charts of 201 recurrent stone formers with 2°HO (uOx ≥ 40 mg/day). The 24-hour urine collections at baseline and after initiation of clinician-directed therapies were analyzed. Mixed models were constructed to analyze uOx over time for individual patients and as a group. Subgroup analyses were performed for enteric and idiopathic 2°HO. Coefficients of variation were computed using the root mean square error from linear models. RESULTS The etiology of 2°HO was enteric in 17.9% and idiopathic in 82.1% of patients. Among the 943 urine collections analyzed, 196 oxalate values were derived from the enteric group and 747 from the idiopathic group. The median number of uOx values measured per person was four. The median 24-hour uOx (mg/day) was significantly higher for the enteric group than for the idiopathic group at the time of diagnosis: 64.4 (interquartile range [IQR]=48-90) vs 46.0 (IQR=38-56), P<0.001) and during follow-up (58.2 [IQR=46-86] vs 44.2 [IQR=35-53], P<0.001). Over a median follow-up of 22.5 months, 44.4% of the enteric and 61.8% of the idiopathic patients had at least one normal uOx value (P=0.06). The coefficients of variation for the enteric and idiopathic groups were 40.8% and 27.3%, respectively, with variation randomly displayed in either direction for both groups. CONCLUSIONS Among patients with 2°HO, uOx demonstrates significant random variation over time even with the incorporation of standard treatments, with enteric HO demonstrating higher values and greater variance than idiopathic HO.