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Laparoscopic Radical Nephrectomy and Inferior Vena Cava Thrombectomy in the Treatment of Renal Cell Carcinoma

Abstract Background

Radical nephrectomy with inferior vena cava (IVC) thrombectomy is the preferred treatment for renal cell carcinoma (RCC) with IVC thrombus. However, IVC thrombectomy using a laparoscopic approach has not been reported for high-level thrombi.

Objective

To describe the surgical technique for laparoscopic IVC thrombectomy in patients with different thrombus levels and to assess its safety and feasibility.

Design, setting, and participants

Retrospective review of medical records for 11 patients with right-side RCC, including six patients with level II IVC thrombus and five patients with level IV thrombus.

Surgical procedure

Laparoscopic thrombectomy for level II thrombus was performed after clamping the infrarenal IVC, left renal vein, and infrahepatic IVC. Laparoscopic thrombectomy and thoracoscope-assisted open atriotomy for level IV thrombus were performed after establishing cardiopulmonary bypass and clamping the infrarenal IVC, left renal vein, and hepatoduodenal ligament.

Measurements

The intraoperative variables, postoperative complications, and surgical outcomes were assessed.

Results and limitations

The median operative time was 210 min. The median IVC clamping time for patients with level II and level IV thrombus was 16.5 and 31 min, respectively. The median estimated blood loss was 510 ml, and no major intraoperative or postoperative complications occurred. One patient with level IV thrombus died of brain metastasis 6 mo after the operation, and the remaining ten patients had no local recurrence or distant metastasis during a median follow-up period of 31 mo.

Conclusions

Laparoscopic IVC thrombectomy for level II thrombus and well-selected level IV thrombus may be a safe and technically feasible alternative to open surgery.

Patient summary

We studied the treatment of patients with an inferior vena cava thrombus at different levels using a laparoscopic approach. This technique was safe and feasible in well-selected patients.

Take Home Message

We report on our experience of laparoscopic thrombectomy for the treatment of renal cell carcinoma with level II and level IV thrombus in the inferior vena cava (IVC) in 11 patients. The outcomes demonstrate that laparoscopic IVC thrombectomy for level II thrombus and well-selected level IV thrombus may be a safe and technically feasible alternative to open surgery.

Keywords: Renal cell carcinoma, Laparoscopy, Thrombus, Thrombectomy, Cardiopulmonary bypass.

Footnotes

a Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China

b Department of Cardiothoracic Surgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, China

Corresponding author. Department of Urology, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, China. Tel. +86 137 70738899, +86 25 68136851; Fax: +86 25 83780079.

These authors contributed equally.

Article information

PII: S0302-2838(14)01266-4
DOI: 10.1016/j.eururo.2014.12.011
© 2014 European Association of Urology, Published by Elsevier B.V.

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Estrogen Attenuates TGF-β1 Induced Elastogenesis in Rat Urethral Smooth Muscle Cells by Inhibiting Smad Response Elements

Our objective is to investigate the effect and mechanism of estrogen (E2) on elastogenesis in the urethral smooth muscle cells in vitro.
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Management of Pain in ADPKD and Anatomy of Renal Innervation

Chronic pain is a prominent feature of autosomal dominant polycystic kidney disease (ADPKD) that is difficult to treat and manage, often resulting in a decrease in quality of life. Understanding the underlying anatomy of renal innervation and different etiologies of pain that occur in ADPKD can help to guide proper treatments to manage pain. Reviewing the previously studied treatments for pain in ADPKD can help to characterize treatment in a stepwise fashion.
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Total Bladder and Posterior Urethral Reconstruction: Salvage Technique for Defunctionalized Bladder with Recalcitrant Posterior Urethral Stenosis

Recalcitrant posterior urethral stenosis is a challenging disease entity; when combined with a defunctionalized bladder, cutaneous urinary diversion is the most common surgical option.We present a novel technique of total lower urinary tract reconstruction, combining salvage cystectomy, ileal neobladder formation, and urethral pull-through as an orthotopic alternative patients with both a defunctionalized bladder and recalcitrant posterior urethral stenosis.
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A National Multicenter Phase 2 Study of Prostate-specific Antigen (PSA) Pox Virus Vaccine with Sequential Androgen Ablation Therapy in Patients with PSA Progression: ECOG 9802

Abstract Background

E9802 was a phase 2 multi-institution study conducted to evaluate the safety and effectiveness of vaccinia and fowlpox prostate-specific antigen (PSA) vaccine (step 1) followed by combination with androgen ablation therapy (step 2) in patients with PSA progression without visible metastasis.

Objective

To test the hypothesis that vaccine therapy in this early disease setting will be safe and have a biochemical effect that would support future studies of immunotherapy in patients with minimal disease burden.

Design, setting, and participants

Patients who had PSA progression following local therapy were treated with PROSTVAC-V (vaccinia)/TRICOM on cycle 1 followed by PROSTVAC-F (fowlpox)/TRICOM for subsequent cycles in combination with granulocyte-macrophage colony-stimulating factor (step 1). Androgen ablation was added on progression (step 2).

Outcome measurements and statistical analysis

Step 1 primary end points included progression at 6 mo and characterization of change in PSA velocity pretreatment to post-treatment. Step 2 end points included PSA response with combined vaccine and androgen ablation.

Results and limitations

In step 1, 25 of 40 eligible patients (63%) were progression free at 6 mo after registration (90% confidence interval [CI], 48–75). The median pretreatment PSA velocity was 0.13 log(PSA)/mo, in contrast to median postregistration velocity of 0.09 log(PSA)/mo (p = 0.02), which is an increase in median PSA doubling time from 5.3 mo to 7.7 mo. No grade ≥4 treatment-related toxicity was observed. In the 27 patients eligible and treated for step 2, 20 patients achieved a complete response (CR) at 7 mo (CR rate: 74%; 90% CI, 57–87). Although supportive of larger studies in the cooperative group setting, this study is limited by the small number of patients and the absence of a control group as in a phase 3 study.

Conclusions

A viral PSA vaccine can be administered safely in the multi-institutional cooperative group setting to patients with minimal disease volume alone and combined with androgen ablation, supporting the feasibility of future phase 3 studies in this population.

Patient summary

These data support consideration of vaccine therapy earlier in the course of prostate cancer progression with minimal disease burden in future studies of vaccine approaches in earlier stages of disease.

Take Home Message

These data support consideration of vaccine therapy earlier in the course of prostate cancer progression with minimal disease burden in future studies of vaccine approaches in earlier stages of disease.

Keywords: Prostate cancer, Pox virus, Vaccine, PSA.

Footnotes

a Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA

b Dana-Farber Cancer Institute, Boston, MA, USA

c Beth Israel Deaconess Medical Center, Boston, MA, USA

d Indiana University Simon Cancer Center, Indianapolis, IN, USA

e Johns Hopkins University, Baltimore, MD, USA

f National Cancer Institute, Bethesda, MD, USA

g University of Pittsburgh, Pittsburgh, PA, USA

h UW Carbone Cancer Center, University of Wisconsin, Madison, WI, USA

Corresponding author. Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ 08901, USA. Tel. +1 732 235-8064; Fax: +1 732 235 8094.

Article information

PII: S0302-2838(14)01265-2
DOI: 10.1016/j.eururo.2014.12.010
© 2014 Published by Elsevier B.V.

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Quality of Life After Primary Treatment for Localized Prostate Cancer: Long-term Considerations

Refers to article:

Long-term Health-related Quality of Life After Primary Treatment for Localized Prostate Cancer: Results from the CaPSURE Registry

Sanoj Punnen, Janet E. Cowan, June M. Chan, Peter R. Carroll and Matthew R. Cooperberg

Accepted 29 August 2014

Footnotes

Emory University School of Medicine, Department of Urology, Atlanta, GA, USA

Corresponding author. Department of Urology, Emory University School of Medicine, 1365 Clifton Rd NE, Bldg B Suite 1400, Atlanta, GA 30322, USA. Tel. +1 404 778 6874.

Article information

PII: S0302-2838(14)01252-4
DOI: 10.1016/j.eururo.2014.12.003
© 2014 European Association of Urology, Published by Elsevier B.V.

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Health Economic Changes as a Result of Implementation of Targeted Therapy for Metastatic Renal Cell Carcinoma: National Results from DARENCA Study 2

Abstract Background

Limited data exist on the economic consequences of implementing targeted therapy (TT) for metastatic renal cell carcinoma (RCC) in a real-world setting.

Objective

To analyze health care and productivity costs for TT implementation in a national cohort of patients.

Design, setting, and participants

Costs were measured per patient per year during a 2-yr follow-up during 2002–2005 (immunotherapy only) and 2006–2009 (TT implementation). All Danish patients with a diagnosis code for RCC and a procedure code for TT or immunotherapy were linked to the Danish National Patient Registry (contains information on all contacts with primary and secondary health sector). Health care and productivity costs were retrieved from the Danish case-mix system and Coherent Social Statistics, respectively. Drug costs were calculated separately from procedure codes and retail prices.

Outcome measurements and statistical analysis

Generalized linear models were used to analyze costs adjusted for age, gender, and civil status.

Results and limitations

A total of 439 patients were included for 2006–2009 and 192 for 2002–2005. Comparison of the health care cost per patient per year between 2006–2009 and 2002–2005 revealed lower inpatient costs (€11 899 vs €19 944, adjusted relative risk [RR] 0.64), higher outpatient costs (€14 308 vs €6209, RR 2.39), lower radiotherapy costs (€194 vs €633, RR 0.31), higher radiology costs (€676 vs €191, RR 3.73), and higher separately calculated drug costs (€12 040 vs €3103, RR 3.82, allp < 0.001) for the former. Total health care costs per patient per year did not significantly differ (€27 676 vs €27 856, RR 1.05,p = 0.5) between the two periods. Income from employment did not significantly differ between 2006–2009 and 2002–2005 (RR 1.11,p = 0.11) and costs associated with loss of productivity were €7852 and €8265, respectively.

Conclusions

A different pattern of health care costs were observed but total health care costs per patient per year did not significantly differ after implementation of TT for patients with mRCC.

Patient summary

In this nationwide study, we found changes in the pattern of health care costs for patients with metastatic kidney cancer after implementation of targeted therapy compared to an immunotherapy control period; however, total health care costs and income from employment were without significant changes.

Take Home Message

Health care costs per patient per year did not significantly differ after implementation of targeted therapy compared to an immunotherapy control period. This can be attributed to changes in expenses, mainly lower inpatient costs, lower radiotherapy costs, higher radiology services costs, higher outpatient costs, and higher separately calculated drug costs.

Keywords: Cost analysis, Economic analysis, Implementation, Metastatic renal cell carcinoma, National, Population-based, Targeted therapy, Observational.

Footnotes

a Department of Oncology, Herlev Hospital, University of Copenhagen, Herlev, Denmark

b Aarhus University Hospital, Aarhus, Denmark

c Danish Institute for Local and Regional Government Research (KORA), Copenhagen, Denmark

d i2Minds, Aarhus, Denmark

e Department of Urology, University Hospital of Copenhagen Rigshospitalet, Copenhagen, Denmark

f Department of Oncology, Odense University Hospital, Odense, Denmark

Corresponding author. Department of Oncology, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, 2730 Herlev, Denmark. Tel. +45 31627667; Fax: +45 38683010.

Article information

PII: S0302-2838(14)01272-X
DOI: 10.1016/j.eururo.2014.12.017
© 2014 Published by Elsevier B.V.

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Kidney dialysis: taming the inflammatory response

MedicalNewsToday - Thu, 2014-12-18 02:00
Frequent kidney dialysis is essential for the approximately 350,000 end-stage renal disease (ESRD) patients in the United States.
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Re: Outcomes of Vaginal Prolapse Surgery among Female Medicare Beneficiaries: The Role of Apical Support

K. S. Eilber, M. Alperin, A. Khan, N. Wu, C. L. Pashos, J. Q. Clemens and J. T. Anger
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Re: Comparison of 2 Transvaginal Surgical Approaches and Perioperative Behavioral Therapy for Apical Vaginal Prolapse: The OPTIMAL Randomized Trial

M. D. Barber, L. Brubaker, K. L. Burgio, H. E. Richter, I. Nygaard, A. C. Weidner, S. A. Menefee, E. S. Lukacz, P. Norton, J. Schaffer, J. N. Nguyen, D. Borello-France, P. S. Goode, S. Jakus-Waldman, C. Spino, L. K. Warren, M. G. Gantz and S. F. Meikle; Eunice Kennedy Shriver National Institute of Child Health and Human Development Pelvic Floor Disorders Network
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Re: Ipilimumab versus Placebo after Radiotherapy in Patients with Metastatic Castration-Resistant Prostate Cancer that had Progressed after Docetaxel Chemotherapy (CA184-043): A Multicentre, Randomised, Double-Blind, Phase 3 Trial

E. D. Kwon, C. G. Drake, H. I. Scher, K. Fizazi, A. Bossi, A. J. van den Eertwegh, M. Krainer, N. Houede, R. Santos, H. Mahammedi, S. Ng, M. Maio, F. A. Franke, S. Sundar, N. Agarwal, A. M. Bergman, T. E. Ciuleanu, E. Korbenfeld, L. Sengeløv, S. Hansen, C. Logothetis, T. M. Beer, M. B. McHenry, P. Gagnier, D. Liu and W. R. Gerritsen; CA184-043 Investigators
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Re: Effect of Radium-223 Dichloride on Symptomatic Skeletal Events in Patients with Castration-Resistant Prostate Cancer and Bone Metastases: Results from A Phase 3, Double-Blind, Randomised Trial

O. Sartor, R. Coleman, S. Nilsson, D. Heinrich, S. I. Helle, J. M. O’Sullivan, S. D. Fosså, A. Chodacki, P. Wiechno, J. Logue, A. Widmark, D. C. Johannessen, P. Hoskin, N. D. James, A. Solberg, I. Syndikus, N. J. Vogelzang, C. G. O’Bryan-Tear, M. Shan, Ø. S. Bruland and C. Parker
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Re: Prospective Randomized Phase 2 Trial of Intensity Modulated Radiation Therapy with or without Oncolytic Adenovirus-Mediated Cytotoxic Gene Therapy in Intermediate-Risk Prostate Cancer

S. O. Freytag, H. Stricker, M. Lu, M. Elshaikh, I. Aref, D. Pradhan, K. Levin, J. H. Kim, J. Peabody, F. Siddiqui, K. Barton, J. Pegg, Y. Zhang, J. Cheng, N. Oja-Tebbe, R. Bourgeois, N. Gupta, Z. Lane, R. Rodriguez, T. DeWeese and B. Movsas
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News and Announcements

President – Dr. William W. Bohnert, 3500 E. Lincoln Drive, Lot #33, Phoenix, Arizona 85018
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Corrigendum to “Targeted Prostate Cancer Screening in BRCA1 and BRCA2 Mutation Carriers: Results from the Initial Screening Round of the IMPACT Study” [Eur Urol 2014;66:489–99]

Refers to article:

Targeted Prostate Cancer Screening in BRCA1 and BRCA2 Mutation Carriers: Results from the Initial Screening Round of the IMPACT Study

Elizabeth K. Bancroft, Elizabeth C. Page, Elena Castro, Hans Lilja, Andrew Vickers, Daniel Sjoberg, Melissa Assel, Christopher S. Foster, Gillian Mitchell, Kate Drew, Lovise Mæhle, Karol Axcrona, D. Gareth Evans, Barbara Bulman, Diana Eccles, Donna McBride, Christi van Asperen, Hans Vasen, Lambertus A. Kiemeney, Janneke Ringelberg, Cezary Cybulski, Dominika Wokolorczyk, Christina Selkirk, Peter J. Hulick, Anders Bojesen, Anne-Bine Skytte, Jimmy Lam, Louise Taylor, Rogier Oldenburg, Ruben Cremers, Gerald Verhaegh, Wendy A. van Zelst-Stams, Jan C. Oosterwijk, Ignacio Blanco, Monica Salinas, Jackie Cook, Derek J. Rosario, Saundra Buys, Tom Conner, Margreet G. Ausems, Kai-ren Ong, Jonathan Hoffman, Susan Domchek, Jacquelyn Powers, Manuel R. Teixeira, Sofia Maia, William D. Foulkes, Nassim Taherian, Marielle Ruijs, Apollonia T. Helderman-van den Enden, Louise Izatt, Rosemarie Davidson, Muriel A. Adank, Lisa Walker, Rita Schmutzler, Kathy Tucker, Judy Kirk, Shirley Hodgson, Marion Harris, Fiona Douglas, Geoffrey J. Lindeman, Janez Zgajnar, Marc Tischkowitz, Virginia E. Clowes, Rachel Susman, Teresa Ramón y Cajal, Nicholas Patcher, Neus Gadea, Allan Spigelman, Theo van Os, Annelie Liljegren, Lucy Side, Carole Brewer, Angela F. Brady, Alan Donaldson, Vigdis Stefansdottir, Eitan Friedman, Rakefet Chen-Shtoyerman, David J. Amor, Lucia Copakova, Julian Barwell, Veda N. Giri, Vedang Murthy, Nicola Nicolai, Soo-Hwang Teo, Lynn Greenhalgh, Sara Strom, Alex Henderson, John McGrath, David Gallagher, Neil Aaronson, Audrey Ardern-Jones, Chris Bangma, David Dearnaley, Philandra Costello, Jorunn Eyfjord, Jeanette Rothwell, Alison Falconer, Henrik Gronberg, Freddie C. Hamdy, Oskar Johannsson, Vincent Khoo, Zsofia Kote-Jarai, Jan Lubinski, Ulrika Axcrona, Jane Melia, Joanne McKinley, Anita V. Mitra, Clare Moynihan, Gad Rennert, Mohnish Suri, Penny Wilson and Emma Killick The IMPACT Collaborators. Sue Moss and Rosalind A. Eeles

Accepted 2 January 2014

September 2014 (Vol. 66, Issue 3, pages 489 - 499)

Footnotes

a Cancer Genetics Unit and Academic Urology Unit, Royal Marsden NHS Foundation Trust, London, UK

b Oncogenetics Team, Institute of Cancer Research, London, UK

Corresponding author. The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, 15 Cotswold Road, Sutton SM2 5NG, UK. Tel. +44 208 722 4094; Fax: +44 208 722 4110.

Article information

PII: S0302-2838(14)01243-3
DOI: 10.1016/j.eururo.2014.12.001
© 2014 Published by Elsevier B.V.

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