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Introduction: Minimally invasive radical hysterectomy (MIRH) has been reported to have a four-fold increase in recurrence compared to open radical hysterectomy (ORH) for the treatment of early-stage cervical cancer. The cause for the inferior outcomes with MIRH is unclear. However, the use of a uterine manipulator and the lack of tumor containment strategies may contribute to tumor seeding in previous MIRH approaches. Objective: Determine the feasibility and early oncologic outcomes of a novel robotic-assisted surgical technique for the treatment of early-stage cervical cancer, Total Intracorporeal Robotic Radical Hysterectomy with Vaginal Cerclage (TIRRHVC). Methods: Retrospective cohort study. Results: Twenty-six patients between 2018 and 2022 underwent the TIRRHVC procedure after being counseled on the risks and benefits of ORH and TIRRHVC; these 26 patients’ demographics, clinical, surgical, and oncologic outcomes were reviewed retrospectively. Seventeen patients (65.4 %) had clinical stage IB1 and 9 (34.6 %) were IB2 cervical cancer according to FIGO 2018 guidelines. Following hysterectomy and lymphadenectomy, 4 patients were upstaged. The average pathologic tumor size was 2.66 cm (0 cm – 5.6 cm); 65 % of tumors were > 2 cm. There were no intraoperative complications. There were 13 postoperative complications, including 10 urinary tract infections. Eleven patients (42.3 %) received adjuvant therapy. The average follow-up period was 2.8 years (IQR 2.3–3.6). Only one patient has recurred at 3.6 years. One patient expired from causes unrelated to gynecologic cancer. The 3-year disease free survival is 95.5 %. Conclusion: These promising early oncologic outcomes are encouraging that TIRRHVC may be a treatment option that offers the benefits of minimally invasive surgery without compromising oncologic outcomes.

Objective: To compare the perioperative, oncological, and functional outcomes between single-port robot-assisted radical prostatectomy (SP-RARP) and multiport robot-assisted radical prostatectomy (MP-RARP) via a meta-analysis. Methods: For relevant articles, three electronic databases, including PubMed, Scopus, and Web of Science, were searched from their inception until January 15, 2022. A meta-analysis has been reported in line with PRISMA 2020 and AMSTAR Guidelines. The risk ratio and weighted mean difference (MD) were applied for the comparison of dichotomous and continuous variables with 95% confidence intervals (CI). Results: Of the 368 retrieved abstracts, 41 underwent full-text review, and seven studies were included in the final analysis, comprising a total cohort of 1,934 cases of RARP (355 SP-RARP cases and 1,579 MP-RARP cases). Compared to MP-RARP, the SP-RARP group had less postoperative pain score (MD = –0.7, 95% CI –1 to –0.4, P

This is a response to the letter to the editor from Dr. Ali et al. from Aga Khan University, Karachi, Pakistan.

Objectives: We aim to characterize the serial quantitative apparent diffusion coefficient (ADC) changes of the target disease volume using diffusion-weighted imaging (DWI) acquired weekly during radiation therapy (RT) on a 1.5 T MR-Linac and correlate these changes with tumor response and oncologic outcomes for head and neck squamous cell carcinoma (HNSCC) patients as part of a programmatic R-IDEAL biomarker characterization effort. Methods: Thirty patients with HNSCC who received curative-intent RT at MD Anderson Cancer Center, were included. Baseline and weekly MRI were obtained, and various ADC parameters were extracted from the regions of interest (ROIs). Baseline and weekly ADC parameters were correlated with response during and after RT, and the recurrence using the Mann-Whitney U test. The Wilcoxon signed-rank test was used to compare the weekly ADC versus baseline values. Weekly volumetric changes (Δvolume) for each ROI were correlated with ΔADC using Spearman’s Rho test. Recursive partitioning analysis (RPA) identified the optimal ΔADC threshold associated with different oncologic outcomes. Results: There was a significant rise in all ADC parameters at different time points of RT compared to baseline for both gross primary disease (GTV-P) and gross nodal disease volumes (GTV-N). The increased ADC values for GTV-P were statistically significant only for primary tumors achieving complete remission (CR) during RT. RPA identified GTV-P ΔADC 5th percentile > 13% at the mid-RT as the most significant parameter associated with primary tumors’ CR during RT (p

Introduction: Ipsilateral breast tumor recurrence (IBTR) remains a concern despite standard treatments. Advances in early detection have shifted surgical paradigms towards less invasive approaches. While repeat sentinel lymph node biopsy (rSLNB) emerges as a viable option according to the 2023 National Comprehensive Cancer Network (NCCN) guidelines, its efficacy remains uncertain. This study aimed to assess lymphatic drainage patterns in IBTR and evaluate the feasibility of rSLNB, along with analyzing oncologic outcomes., Methods: A retrospective analysis involving 78 patients with IBTR who had prior breast-conserving surgery (BCS) with sentinel lymph node biopsy (SLNB) and adjuvant whole breast irradiation (WBI) at Samsung Medical Center was conducted. Data on patient characteristics, lymphatic mapping techniques, and oncologic outcomes were collected and analyzed., Results: Among 78 patients with IBTR, 82.1 % underwent successful rSLNB, predominantly detecting lymphatic drainage to the ipsilateral axilla (80.8 %). The initial tumor location correlated significantly with failed lymphatic mapping (p = 0.019). A third event occurred in 28.8 % of invasive IBTR cases, notably associated with postmenopausal status, higher T stages, and HR(-)/HER2(-) subtype (p < 0.001). The risk of a third event increased by over 50 % within a 2-year interval post-IBTR., Conclusion: rSLNB in patients with IBTR, particularly for tumors initially located outside the upper-outer quadrant, demonstrated technical feasibility. The combined use of blue dye with lymphoscintigraphy may enhance rSLNB success rates. Active surveillance, especially for triple negative IBTR cases, may be important due to their aggressive nature and rapid progression potential within a short interval post-IBTR., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Colon cancer obstruction is one of the most serious conditions in colorectal surgery. However, the use of self-expanding metallic stent (SEMS) has made it possible to avoid emergency surgery and stoma creation, therefore enabling minimally invasive surgery and one-stage operation. In this study, we aimed to investigate whether there is an optimal interval from SEMS to surgery for the best long-term oncologic outcomes., Methods: Obstructive colon cancer patients treated with SEMS insertion and received surgery were included in the study. Patient data were retrospectively reviewed in prospectively collected data. Using the ROC curve, the optimal interval to surgery after SEMS insertion was 10 days; the patients were divided into the early surgery group (≤10 days, ES) and the late surgery group (>10 days, LS). Factors contributing to the 5-year disease-free survival (DFS) and overall survival (OS) were analyzed., Results: 83 patients were included in this study. Eight patients (9.6 %) had SEMS insertion failure, with 3 perforations and 5 failed expansions. There were no differences between the ES group and the LS group in terms of pathologic characteristics, incidence of stoma creation, and adjuvant chemotherapy. Twenty-six patients (31.3 %) had recurrences; local (Arnarson et al., 2023) [6], peritoneal seeding (Lee et al., 2013) [8], liver (Ho et al., 2017) [11], lung [7], bone (van Hooft et al., 2020) [2], and abdominal wall metastasis (Chen and Sheen-Chen, 2000) [1]. The 5-year DFS rate was significantly better in the ES group than the LS group (74.3 % vs. 55.01 %; p = 0.0394). The 5-year OS was slightly better in the ES group than the LS group (76.11 % vs. 58.75 %; p = 0.0901). In univariable analysis, the ES group showed a lower risk of recurrence than the LS group (OR: 0.447 [0.204-0.984], p = 0.0455), but this was not reproduced in the multivariable analysis., Conclusion: This study has shown that the long-term oncologic outcomes were better in patients who received surgery after SEMS within 10 days. Hence, we propose with caution that elective surgery might be suggested to take place within 10 days from SEMS insertion for better oncologic outcomes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)

Purpose: Radiation therapy (RT) is the standard treatment for patients with inoperable skin malignancies of the head and neck region (H&N), and as adjuvant treatment post surgery in patients at high risk for local or regional recurrence. This study reports clinical outcomes of intensity-modulated proton therapy (IMPT) for these malignancies. Materials and Methods: We retrospectively reviewed cases involving 47 patients with H&N malignancies of the skin (squamous cell, basal cell, melanoma, Merkel cell, angiosarcoma, other) who underwent IMPT for curative intent between July 2016 and July 2019. Overall survival was estimated via Kaplan-Meier analysis, and oncologic outcomes were reported as cumulative incidence with death as a competing risk. Results: The 2-year estimated local recurrence rate, regional recurrence rate, local regional recurrence rate, distant metastasis rate, and overall survival were 11.1% (95% confidence interval [CI], 4.1%–30.3%), 4.4% (95% CI, 1.1%–17.4%), 15.5% (95% CI, 7%-34.3%), 23.4% (95% CI, 5.8%–95.5%), and 87.2% (95% CI, 75.7%–100%), respectively. No patient was reported to have a grade 3 or higher adverse event during the last week of treatment or at the 3-month follow-up visit. Conclusion: IMPT is safe and effective in the treatment of skin malignancies of the H&N.

Introduction: Minimally invasive radical hysterectomy (MIRH) has been reported to have a four-fold increase in recurrence compared to open radical hysterectomy (ORH) for the treatment of early-stage cervical cancer. The cause for the inferior outcomes with MIRH is unclear. However, the use of a uterine manipulator and the lack of tumor containment strategies may contribute to tumor seeding in previous MIRH approaches., Objective: Determine the feasibility and early oncologic outcomes of a novel robotic-assisted surgical technique for the treatment of early-stage cervical cancer, Total Intracorporeal Robotic Radical Hysterectomy with Vaginal Cerclage (TIRRHVC)., Methods: Retrospective cohort study., Results: Twenty-six patients between 2018 and 2022 underwent the TIRRHVC procedure after being counseled on the risks and benefits of ORH and TIRRHVC; these 26 patients' demographics, clinical, surgical, and oncologic outcomes were reviewed retrospectively. Seventeen patients (65.4 %) had clinical stage IB1 and 9 (34.6 %) were IB2 cervical cancer according to FIGO 2018 guidelines. Following hysterectomy and lymphadenectomy, 4 patients were upstaged. The average pathologic tumor size was 2.66 cm (0 cm - 5.6 cm); 65 % of tumors were > 2 cm. There were no intraoperative complications. There were 13 postoperative complications, including 10 urinary tract infections. Eleven patients (42.3 %) received adjuvant therapy. The average follow-up period was 2.8 years (IQR 2.3-3.6). Only one patient has recurred at 3.6 years. One patient expired from causes unrelated to gynecologic cancer. The 3-year disease free survival is 95.5 %., Conclusion: These promising early oncologic outcomes are encouraging that TIRRHVC may be a treatment option that offers the benefits of minimally invasive surgery without compromising oncologic outcomes., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Author(s).)

Background: The gold standard treatment offered to patients with high-risk upper tract urothelial carcinoma (UTUC) is radical nephro-ureterectomy (RNU). The procedure may be performed open, laparoscopic or with robotic assistance. Herein, we describe our technique of performing robot-assisted RNU. Methods: We retrospectively reviewed patients who underwent RNU for high-risk UTUC from January 2006 to June 2017. Sociodemographic, preoperative, intraoperative, perioperative, outcomes, and pathologic data were recorded. Results and Limitations: A total of 90 patients with a mean age of 70.9 and BMI 27.4 underwent robot-assisted RNU with a minimum of 12 month follow-up. Average operative time was 215 min with a mean estimated blood loss of 140 mL. 37% of patients were diagnosed with pT3 or greater disease with a pN+ rate of 17%. We report a 4% Clavien ≥ 3 complication rate. 5-year overall survival and cancer-specific survival were 42% and 58%, respectively. Conclusions: Robot-assisted RNU is an efficacious and technically feasible operation that affords advantages over standard laparoscopic or open approaches. Regardless of approach, sound oncologic principles should be emphasized.

Introduction: Cisplatin-based systemic chemotherapy is recommended as neoadjuvant treatment for muscle-invasive bladder cancer (MIBC) before radical cystectomy (RC). However, clinical challenges include the possibility of primary chemoresistance and limited feasibility in patients with renal impairment. This study investigated the efficacy and safety profiles of neoadjuvant chemoradiotherapy (NCRT) followed by RC., Materials and Methods: We retrospectively analyzed 119 patients with nonmetastatic MIBC, who were pathologically diagnosed with urothelial carcinoma and underwent NCRT before RC. The pathological response to NCRT was evaluated using RC specimens. Recurrence-free survival (RFS) and cancer-specific survival (CSS) were compared according to pathological responses to NCRT., Results: Of the 119 patients, 111 (93%) underwent RC; ypT0 and downstaging to ≤ypT1 were observed in 42 (38%) and 76 (68%) patients, respectively. In the multivariable analysis, smaller tumor size was independently associated with ypT0. During a median follow-up of 5.2 years, 28 (25%) patients developed recurrence and 22 (20%) died of bladder cancer after RC. The 5-year RFS and CSS rates were 75% and 80%, respectively. The 5-year RFS rates in patients with ypT0, ypTa/is/1, and ≥ypT2 were 87%, 87%, and 46%, respectively. Similarly, patients with ypT0 and ypTa/is/1 had more favorable CSS (90% and 87% at 5 years, respectively) than those with ≥ypT2 (60%, P = .001). None of the patients experienced ≥grade 4 adverse events related to NCRT or ≥grade 4 complications of RC., Conclusions: This study demonstrated sufficient efficacy and safety profile of NCRT followed by RC. Chemoradiotherapy may be a helpful alternative for neoadjuvant treatment before RC., Competing Interests: Disclosure The authors have stated that they have no conflict of interest., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objectives: Social determinants of health (SDOH) can influence access to cancer care, clinical trials, and oncologic outcomes. We investigated the association between SDOH, distance from treatment center, and treatment type with outcomes in human papillomavirus associated oropharyngeal squamous cell carcinoma [HPV(+)OPSCC] patients treated at a tertiary care center., Study Design: Retrospective review., Methods: HPV(+)OPSCC patients treated surgically from 2006 to 2021 were selected from our departmental Oropharyngeal Cancer RedCap database. Demographic data, treatment, and oncologic outcomes were extracted. Distance was calculated in miles between the centroid of each patient zip code and our hospital zip code (zipdistance)., Results: 874 patients (89 % male; mean age: 58 years) were identified. Most patients (96 %) reported Non-Hispanic White as their primary race. 204 patients (23 %) had a high-school degree or less, 217 patients (25 %) reported some college education or a 2-year degree, 153 patients (18 %) completed a four-year college degree, and 155 patients (18 %) had post-graduate degrees. Relative to those with a high-school degree, patients with higher levels of education were more likely to live further away from our institution (p < 0.0001). Patients who received adjuvant radiation therapy elsewhere lived, on average, 104 miles further away than patients receiving radiation at our institution (Estimate 104.3, 95 % CI 14.2-194.4, p-value = 0.02). In univariable Cox PH models, oncologic outcomes did not significantly differ by zipdistance., Conclusions: Education level-and access to resources-varied proportionally to a patient's distance from our center. Patients travelling further distances for surgical management of OPSCC were more likely to pursue adjuvant radiation therapy at an outside institution. Distance traveled was not associated with oncologic outcomes. Breaking down barriers to currently excluded populations may improve access to clinical trials and improve oncologic outcomes for diverse patient populations., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: The oncologic safety of preserving the pectoralis major fascia (PMF) in patients with breast cancer remains controversial. In this study, we aimed to determine the impact of preserving the PMF on long-term oncologic outcomes in patients with breast cancer treated with immediate implant-based breast reconstruction (IBBR) following conservative mastectomy., Methods: We selected women with early-stage breast cancer who underwent conservative mastectomy and submuscular IBBR in our center during 2014-2019. The propensity score matching method was used to create well-balanced fascia-preserved and fascia-removed groups. Locoregional recurrence-free survival (LRFS), disease-free survival (DFS), distant metastasis-free survival (DMFS), and overall survival (OS) rates were calculated using the Kaplan-Meier method and compared using log-rank tests between the fascia-preserved and fascia-removed groups., Results: After matching, there were 219 patients in each group. The mean follow-up time was 64.8 ± 18.1 months for the fascia-preserved group and 64.9 ± 18.4 months for the fascia-removed group. There were no significant differences between the groups in terms of LRFS (91.3% vs. 93.8%; p = 0.818), DMFS (94.0% vs. 92.3%; p = 0.056), DFS (89.9% vs. 88.4%; p = 0.261), and OS (95.8% vs. 95.4%; p = 0.783) rates. In the fascia-preserved group, 61.5% of the locoregional recurrence events occurred within 2 years after surgery., Conclusion: Preservation of the PMF did not significantly impact the long-term oncologic outcomes in patients with breast cancer who underwent conservative mastectomy and IBBR. The PMF might be safely preserved in patients without suspicious tumor invasion into this fascia., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest., (Copyright © 2023 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Introduction: Local prostate cancer recurrence following radiotherapy (XRT) or cryoablation (CRYO) may be addressed with salvage cryotherapy (SCT), although little is known about how the primary treatment modality affects SCT results. Oncologic and functional outcomes of patients who underwent SCT after primary XRT (XRT-SCT) or cryoablation (CRYO-SCT) were studied., Methods: Data was collected using the Duke Prostate Cancer database and the Cryo On-Line Data (COLD) registry. The primary outcome was biochemical progression-free survival (BPFS).  Urinary incontinence, rectourethral fistula, and erectile dysfunction were secondary outcomes. The Kaplan-Meier log-rank test and univariable/multivariable Cox proportional hazards (CPH) models were utilized to evaluate BPFS between groups., Results: 419 XRT-SCT and 63 CRYO-SCT patients met inclusion criteria, that was reduced to 63 patients in each cohort after propensity matching. There was no difference in BPFS at 2 and 5 years both before (P = .5 and P = .7) and after matching (P = .6 and P = .3). On multivariable CPH, BPFS was comparable between treatment groups (CRYO-SCT, HR=1.1, [0.2-2.2]).  On the same analysis, BPFS was lower in D'Amico high-risk (HR 3.2, P < .01) and intermediate-risk (HR 1.95, P < .05) categories compared to low-risk. There was no significant difference in functional outcomes between cohorts., Conclusion: Following primary cryotherapy, salvage cryoablation provides comparable intermediate oncological outcomes and functional outcomes compared to primary radiotherapy., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Robotic-assisted laparoscopic prostatectomy (RALP) offers reportedly comparable oncologic outcomes for localized disease compared with open radical retropubic prostatectomy (ORRP). However, the oncologic efficacy of RALP in locally-advanced prostate cancer (PCa) is less clear. We report and compare our experience with RALP and ORRP in men with locally advanced PCa. Methods: Patients with locally advanced PCa (stage T3 or greater) were identified in both robotic and open cohorts. Clinicopathologic features including age, clinical stage, prostate-specific antigen, surgical margins, and Gleason score were reviewed. We further examined the incidence of positive surgical margins, the effect of the surgical learning curve on margins, and the need for adjuvant therapy. Results: From 1997 to 2010, 1,011 patients underwent RALP and 415 patients were identified who underwent radical retropubic prostatectomy (RRP) across four institutions. 140 patients in the RALP group and 95 in the RRP group had locally advanced PCa on final pathology. The overall robotic positive margin rate 47.1% compared with 51.4% in the RRP group. A trend towards a lower positive margin rate was seen after 300 cases in the RALP group, with 66.7% positive margin rate in the first 300 cases compared with 41.8% in the latter 700 cases. In addition, a lower incidence of biochemical recurrence was also noted in the latter cases (30.6% vs. 9.5%). Conclusions: Up to 2 out of 3 men undergoing RALP for locally-advanced PCa had positive margins during our initial experience. However, with increasing surgeon experience the overall positive margin rate decreased significantly and was comparable to the positive margin rate for patients with locally advanced disease undergoing ORRP over four academic institutions. We also noted a lower incidence of biochemical recurrence with increasing RALP experience, suggesting better oncologic outcomes with higher volume. Given this data, RALP has comparable oncologic outcomes compared to ORRP, especially with higher volume surgeons.

Background: Pelvic soft tissue sarcomas are rare. Potentially curative resection remains challenging due to anatomical constraints of true pelvis and tumour spread through various anatomical hiatus. We sought to review the oncological outcomes of surgically managed cases at our centre and determine whether outcomes differ for patients with localised (limited to pelvis) versus extensive disease (with extra-pelvic extension)., Methods: Sixty-seven patients who underwent surgical resection with curative intent at the centre for primary, non-metastatic, WHO intermediate to high-grade soft tissue sarcoma of the true pelvis from January 2012 through January 2020 were analysed. Establishment of the extent of disease was made by review of pre-treatment imaging and surgical notes. Oncologic endpoints examined were resection margin, recurrence rate, disease-free and overall survival., Results: Rates of complete oncological resection and disease control were similar for tumours with localised or extensive disease. On logistic regression analysis, tumour grade, and a negative resection margin (R0) correlated with the risk of recurrence (p=<0.05). On further multinomial analysis, R0 resection was associated with improved local control, but not metastatic relapse (p = 0.003). 5-year local recurrence-free and distant metastasis-free survival were 61.3% and 67.1%, respectively. Five and 10-year overall survival were 64% and 36%, respectively. Age >50 years and high tumour grade were associated with a worse outcome (p < 0.05)., Conclusions: When potentially curative surgery is performed for pelvic sarcoma, disease-extent does not influence oncologic outcomes. While a complete oncologic resection determines the risk of local recurrence, tumour grade and metastatic relapse remain primary prognostic determinants for overall survival., Competing Interests: Declaration of competing interest None., (Crown Copyright © 2023. Published by Elsevier Ltd. All rights reserved.)

Introduction and Objective: The bladder exstrophy-epispadias complex (BEEC) is a rare spectrum of congenital genitourinary malformations with an incidence of 1:10,000 to 1:50,000. Advances in reconstructive surgical techniques have improved clinical outcomes, but there is a paucity in data about disease sequela in adulthood. This is the largest survey to date in the United States exploring the urinary continence, bladder management, and oncologic outcomes in adults with BEEC., Methods: Respondents were over the age of 18 with a diagnosis of bladder exstrophy, cloacal exstrophy, or epispadias. They were treated at the authors' institution, included in the Association for the Bladder Exstrophy Community (A-BE-C) mailing list, and/or engaged in A-BE-C social media. A survey was created using uniquely designed questions and questionnaires. Survey responses between May 2020 and July 2020 were processed using Research Electronic Data Capture (REDCap). Quantitative and qualitative statistics were used to analyze the data with significance at p < 0.05., Results: A total of 165 patients completed the survey. The median age was 31.5 years (IQR 25.9-45.9). Many patients considered themselves continent of urine, with a median satisfaction score of 74 (IQR 50-97) on a scale from 0 (consider themselves to be completely incontinent) to 100 (consider themselves to be completely continent). There was less leakage among those with a continent urinary diversion compared to those who void or catheterize per urethra (p = 0.003). Patients with intestinal-urinary tract reconstruction, such as augmentation cystoplasty or neobladder creation, were more likely to perform bladder irrigations (p = 0.03). Patients with continent channels were more likely to report UTI than all other forms of bladder management (89.0% vs. 66.2%, p = 0.003). Three (1.9%) patients were diagnosed with bladder cancer. A small portion of patients (27.2%) were given bladder cancer surveillance recommendations by a physician., Discussion: Most patients achieved a satisfactory level of urinary continence, with the highest continence rates in those with a continent urinary diversion. Those with intestinal-urinary tract reconstruction were more likely to perform bladder irrigations, perhaps to avoid complications from intestinal mucous production. The rates of self-reported UTI and were higher in patients with continent channels, but recurrent UTIs were not affected by the type of genitourinary reconstruction. Bladder cancer exists in this population, highlighting the need for long-term follow-up., Conclusion: Most BEEC patients achieve a satisfactory level of urinary continence, with the best outcomes in those with a continent urinary diversion. This population requires long-term follow-up with a transitional urologist to ensure adequate oncologic care., Competing Interests: Conflicts of interest The authors have no conflicts of interest to disclose., (Copyright © 2022 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Introduction: Percutaneous microwave ablation (MWA) of renal masses (RM) is still considered experimental as opposed to established procedures such as cryoablation (CA). We aimed to compare perioperative, functional and oncological outcomes of patients with RM treated with CA and MWA., Materials and Methods: Data from 116 (69.9%) and 50 (30.1%) patients treated with CA and MWA for RM were analyzed. Patients' demographics and perioperative data were collected including nephrometry scores, complications, pre- and postprocedural renal function. Tumor persistence and recurrence were recorded. Descriptive statistics compared functional outcomes between groups. Cox regression analyses tested risk factors associated with recurrence., Results: Groups were similar in terms of RM diameter, nephrometry scores and histology distribution. Median follow-up was 26 (13-46) and 24 (14-36) months for CA and MWA, respectively. The rate of overall (36.2% for CA vs. 24% for MWA, P= .1) and major (Clavien ≥ 3a) complications (1.7% vs. 5.4%, P = .1) were similar among groups. The median decline of renal function after 6 months follow-up did not differ between CA and MWA (P = .8). Tumor persistence [4.3% vs. 12%] and recurrence [9.5% and 7.1%] rates were similar for CA and MWA. Three years recurrence free and overall survival were 91% versus 95% (log-rank P = .77) and 80 versus 88% (log-rank P = .23) in the CA and MWA groups, respectively. At Cox analysis no predictors were found associated with recurrence., Conclusion: Despite being considered still experimental, MWA showed comparable outcomes relative to CA in terms of safety, preservation of renal function and oncological efficacy., (Copyright © 2022. Published by Elsevier Inc.)

Introduction: CO 2 transoral laser microsurgery (CO 2 -TOLMS) has pushed the indications of partial surgery of the larynx regardless the age of the patient., Objective: To evaluate the complications and the oncologic and functional outcomes of CO 2 -TOLMS in patients older and younger than 70 years., Methods: Retrospective analysis of 1244 consecutive laryngeal carcinomas treated with CO 2 -TOLMS. Complications, length of hospitalization, functional and survival outcomes were evaluated., Results: The mean age was 64.2 ± 11.1 years (20-96). Four hundred and sixteen patients were older than 70 years and 104 older than 80 years. The main location was the glottis (912), followed by the supraglottis (332). There were no differences in pT classification between the age groups. No differences were observed in voice outcomes. A higher rate of signs of aspiration at the glottic location was observed for those older than 70 years (2.1 % vs 5 %, p = 0.027). The need for definitive gastrostomy in supraglottic tumours was higher in those older than 70 years (0 % vs 6.5 %, p: 0.001). In the glottis, no differences in tracheostomy or gastrostomy rates were observed. Five-year overall survival was lower in the older than 70 years. No differences in disease-specific survival were observed in early stages for both locations, but a lower survival was observed in stage III glottic cancer for the older than 70 years., Conclusions: CO 2 -TOLMS is a valid treatment for laryngeal carcinomas in the elderly, with a reduced number of complications and good functional and oncologic outcomes., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Purpose: To investigate the local recurrence rates of men treated with Mohs microsurgery (MMS) for penile carcinoma. The secondary outcome was surgical complications from the MMS procedure or the subsequent reconstructive procedures., Materials and Methods: All patients from 2010 to 2020 with penile carcinoma at our institution were seen in a multidisciplinary setting. Patients with Ta, Tis, T1, and T2 disease were considered candidates for MMS. Clinical and pathologic data were collected for analysis. Local recurrence rates were stratified by stage and complications reported per the Clavien-Dindo Grade., Results: A total of 43 patients met inclusion criteria. The median age at diagnosis was 64 years. Stage distribution was Ta in 4.7%, Tis in 58.1%, T1a in 14.0%, T1b in 7.0%, and T2 in 16.3%. No patients had a positive surgical margin after MMS. The overall local recurrence rate was 2% (n = 1) at a median of 47 months. Local recurrence rates at 1, 3, and 5 years for Ta, Tis, and T1 patients were 0%. Local recurrence rates for T2 patients were 14% at 1 year. Complications occurred in 12% (n = 5), all of which were Clavien-Dindo ≤ III., Conclusions: MMS provides effective local control for Ta, Tis, and T1 penile cancer with an overall local recurrence rate of 2% and an acceptable complication rate. A multi-disciplinary team involving urologic oncology, reconstructive urology, and MMS is essential to patient management., Competing Interests: Conflicts of interest The other authors declare no conflict of interest., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objectives: Radical cystectomy (RC) represents the gold standard treatment for high-risk bladder cancer. Despite evidence suggesting that surgical experience correlates with perioperative and oncologic outcomes of robot-assisted RC (RARC), validated tools to assess its quality objectively are lacking. We aimed to evaluate the impact of RC-Pentafecta (absence of early major complications, absence of urinary diversion related sequelae at ≤12 months, absence of soft tissue surgical margins, ≥16 lymph nodes at final pathology and absence of clinical recurrence at ≤12 months) on oncological outcomes and the role of surgical experience on its achievement., Materials and Methods: We retrospectively evaluated 366 patients undergoing RARC with intracorporeal urinary diversion in a single tertiary centre with a minimum of 1 year follow-up. Surgeries were performed using the DaVinci Xi system according to a previously described technique. Kaplan-Meier curves were used to investigate 5-years overall survival and cancer specific mortality-free survival (CSS) according to RC-Pentafecta achievement. Multivariable Cox's regressions were performed to evaluate the impact of RC-Pentafecta on overall mortality. Multivariable logistic regressions were performed to explore the effect of surgical experience on RC-pentafecta achievement. Locally weighted scatterplot smoother function was used to graphically explore this relationship., Results: Patients achieving RC-Pentafecta showed higher 5-year overall survival (71.8% vs. 59.6%, P < 0.001) and CSS (84% vs. 71%, P < 0.001) when compared with patients not achieving it. At multivariable Cox's regression, RC-Pentafecta achievement (HR 0.57, P = 0.03), positive surgical margins (HR 2.48, P = 0.002), pN+ (HR 2.23, P = 0.002), pT≥3 (HR 1.71, P = 0.04) and current smoking status (HR 2.4, P = 0.006) were significant predictors of overall mortality. At multivariable logistic regression surgical experience (OR 1.2, P < 0.001), age (OR 0.93, P = 0.04), previous prostate surgery (OR 0.7, P = 0.02) and pT≥3 (OR 0.8, P = 0.03) were independent predictors of RC-Pentafecta achievement. A linear relationship between surgical experience and RC-Pentafecta achievement, without reaching a plateau, was observed., Conclusions: RC-Pentafecta is a valuable tool to assess surgical quality of RARC and the experience of the center where the surgery is performed and may be used to identify "referral" centers for treatment of high-risk bladder cancer., Competing Interests: Declaration of interest The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript., (Copyright © 2022 Elsevier Inc. All rights reserved.)

With increased therapeutic options in rectal cancer, a central question has become how to tailor therapy to patient preferences to avoid both over and under treatment. Total Neoadjuvant Therapy (TNT), defined as delivering all planned chemotherapy and radiation therapy (RT) before surgery, was developed with the primary goal of improving overall survival through early elimination of micrometastatic disease. In this narrative review assessing patients with operable adenocarcinoma of the rectum, we sought to evaluate TNT versus alternative options with regard to both quality of life (QoL) and oncologic outcomes. Survey data of patient preferences reveal that an increased focus on QoL when discussing options is essential. While evidence favors TNT improving distant metastases-free survival, this has not yet translated to a clear OS benefit. The improved pathologic complete response rate with TNT compared to short course RT or chemoradiation alone suggests proceeding to surgery might result in overtreatment, lending support to a watch-and-wait option for patients with a goal for nonoperative management if a clinical complete response is achieved. Similarly, for select low-risk patients, surgery may be the only local therapy required allowing for safe omission of RT. In the treatment of rectal cancer, the future appears to be moving toward one local therapy. As an alternative to TNT, there is growing support for the concept we define herein as total definitive therapy instead: chemoradiation followed by consolidation chemotherapy, saving surgery only for incomplete responders rather than as part of the initial treatment plan. Also, selective use of RT should be considered for low-risk patients. By thoroughly assessing how these treatment de-escalation options compare to more traditional treatment algorithms, this narrative review provides guidance on how to honor patient preferences for QoL by avoiding treatments that might offer negligible benefits in oncologic outcomes., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: Opioids have been linked to worse oncologic outcomes in surgical patients. Studies in certain cancer types have identified associations between survival and intra-tumoural opioid receptor gene alterations, but no study has investigated whether the tumour genome interacts with opioid exposure to affect survival. We sought to determine whether intraoperative opioid exposure is associated with recurrence-specific survival and overall survival in early-stage lung adenocarcinoma, and whether selected tumour genomics are associated with this relationship. Associations between ketamine and dexmedetomidine and outcomes were also studied., Methods: Surgical patients (N=740) with pathological stage I-III lung adenocarcinoma and next-generation sequencing data were retrospectively reviewed from a prospectively maintained database., Results: On multivariable analysis, ketamine administration was protective for recurrence-specific survival (hazard ratio = 0.44, 95% confidence interval 0.24-0.80; P=0.007), compared with no adjunct. Higher intraoperative oral morphine milligram equivalents were significantly associated with worse overall survival (hazard ratio=1.09/10 morphine milligram equivalents, 95% confidence interval 1.02-1.17; P=0.010). Significant interaction effects were found between morphine milligram equivalents and fraction genome altered and morphine milligram equivalents and CDKN2A, such that higher fraction genome altered or CDKN2A alterations were associated with worse overall survival at higher morphine milligram equivalents (P=0.044 and P=0.052, respectively). In contrast, alterations in the Wnt (P=0.029) and Hippo (P=0.040) oncogenic pathways were associated with improved recurrence-specific survival at higher morphine milligram equivalents, compared with unaltered pathways., Conclusions: Intraoperative opioid exposure is associated with worse overall survival, whereas ketamine exposure is associated with improved recurrence-specific survival in patients with early-stage lung adenocarcinoma. This is the first study to investigate tumour-specific genomic interactions with intraoperative opioid administration to modify survival associations., (Copyright © 2021 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.)

Introduction: Although recent studies have demonstrated the safety of laparoscopic surgery in T4 colon cancer, some patients could have poor prognosis. In this study, we aimed to analyse the risk factors affecting oncologic outcome of laparoscopic surgery., Materials and Methods: Among the 1033 T4 colon cancer patients collected from a multicentre database (2004-2017), 584 patients (458 T4a and 126 T4b) underwent laparoscopic approach for radical surgery. Risk factors associated with 3-year disease-free survival (DFS) and overall survival (OS) were evaluated through multivariate analysis. In addition, subgroups were classified using a combination of risk factors, and the survival rate was evaluated., Results: During this period, 188 (32.2%) had recurrence, and 151 (25.9%) died. In the multivariate analysis for oncologic outcome, elevated carcinoembryonic antigen level (hazard ratio [HR] 1.37) and absence of adjuvant chemotherapy (HR 1.60) were associated with poor DFS. T4b (HR 1.56, 1.46), right-sided location (HR 1.52, 1.42), and open conversion (HR 2.70, 2.12) were independently associated with both poor DFS and OS. When four subgroups were analysed through the combination of tumour location and T stage, the DFS and OS rates were significantly lower in patients with right-sided T4b cancer than in other groups (log-rank p < 0.001)., Conclusion: Right-sided T4b colon cancer for laparoscopic surgery may lead to poor oncologic outcome. This approach could be a caution in suspected cases preoperatively., (Copyright © 2021 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)

Introduction: The objective of this study was to evaluate the safety and feasibility of radiation therapy (RT) to the primary tumor in patients with metastatic castration-resistant prostate cancer (mCRPC)., Patients and Methods: This retrospective study included 105 patients with mCRPC who were treated between April 2004 and May 2019. We divided the patients into 2 groups: patients treated with RT to the primary tumor after they developed CRPC (RT group) and without (non-RT group). The primary purpose was safety assessed using the Common Terminology Criteria for Adverse Events. The secondary purpose included prostate-specific antigen (PSA) response, cancer-specific survival (CSS), and overall survival (OS). Background-adjusted multivariate analyses, with the inverse probability of treatment weighting (IPTW) method, were performed to evaluate impact of RT on CSS and OS., Results: The median age at CRPC diagnosis was 75 years, and the median follow-up period after CRPC diagnosis was 21 months. The adverse events rates related to RT in any grade and grade ≥ 3 were 55% and 23%, respectively. Nine (29%) patients achieved ≥ 30% PSA decline with RT. In multivariate analyses with the IPTW method, the CSS and OS in the RT group were significantly longer than those in the non-RT group. In subgroup analyses with the IPTW method, RT was significantly associated with improved OS in patients aged ≥ 75 years and patients with initial PSA ≥ 500 ng/mL, cT4, Gleason score ≥ 8, and high-volume metastatic burden., Conclusions: RT to the primary tumor is safe and feasible, and it has potential benefits on oncologic outcomes in patients with mCRPC., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Introduction: Gastric adenocarcinoma lymph node retrieval during gastrectomy and survival differ significantly between Asian and Western studies. It is unclear whether such disparities are the result of surgical technique, patient population, or other factors. In this observational study, we aimed to determine whether lymph node retrieval and outcomes differ between White, Black, and Asian American patients undergoing gastrectomy for adenocarcinoma., Materials and Methods: 47,217 cases of gastric resection for gastric adenocarcinoma and its subtypes were identified in the National Cancer Data Base (2000-2015). Differences in demographics, lymph node retrieval, operative outcomes, and survival were compared by self-reported race (White, Black, and Asian)., Results: Asians had greater median lymph node retrieval (17) compared to White (15) and Black (16) patients, P < 0.001. Lymph node ratio was lowest in Asian (0.03) compared to White (0.05) and Black (0.09) patients, P < 0.001. Postoperative mortality was lowest in Asian patients on multivariable analysis (90-day mortality adjusted odds ratio of 0.54, P < 0.001). Median survival was not yet reached for Asian patients but was 39.5 months for White and 43.0 months for Black patients (P < 0.001). Differences in survival by race persisted on multivariable analysis (Asian adjusted hazard ratio was 0.64, 95% CI: 0.59-0.70, P < 0.001)., Conclusions: Asian-American patients with gastric cancer undergoing gastrectomy have greater lymph node retrieval, decreased lymph node ratio, decreased postoperative mortality, and increased long-term survival compared to White or Black Americans. Data suggest factors other than surgical technique and oncologic care may be responsible for gastric adenocarcinoma outcome differences seen between Asian and Western studies., Competing Interests: Declaration of competing interest Drs. Tee, Pirozzi, Brahmbhatt, Raman, and Franko have no personal or financial conflicts of interest., (Copyright © 2020 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)

Introduction: Stereotactic body radiation therapy (SBRT) is a promising curative treatment for early-stage NSCLC. It is unclear if survival outcomes for SBRT are influenced by a lack of pathological confirmation of malignancy and staging of disease in these patients. In this systematic review and meta-analysis, we assess survival outcomes after SBRT in studies with patients with clinically diagnosed versus biopsy-proven early-stage NSCLC., Methods: The main databases were searched for trials and cohort studies without restrictions to publication status or language. Two independent researchers performed the screening and selection of eligible studies. Outcomes were overall survival, cancer-specific survival, and disease-free survival. The inverse variance method and the random effects method for meta-analysis were used to assess pooled survival estimates., Results: A total of 11,195 nonduplicate records were identified by the original search strategy. After screening by title and abstract, 1051 potentially eligible records were identified. A total of 43 articles were included. The comparative studies showed lower 3-year overall survival and lower 2-year and 5-year cancer-specific survival for biopsy-proven disease compared to clinical disease. However, 5-year overall survival was the same for both groups. For the pooled estimates, 3-year disease-free survival and 2-year cancer-specific survival were lower for biopsied disease., Conclusions: Results of this systematic review and meta-analysis show a discrepancy in oncological outcomes for patients undergoing SBRT for suspected early-stage NSCLC in whom there is pathologic conformation of malignancy and those who there is only a clinical diagnose of NSCLC. These results emphasize the importance of obtaining pathologic proof of malignancy., (Copyright © 2019 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.)

Background: The extension of lymphadenectomy for GA remains on debate even after Eastern and Western clinical trials. The main concern is if morbidity of extended lymphadenectomy could be justified based on benefits in oncologic outcomes. This study addressed the extension of lymphadenectomy as a prognostic factor of overall survival (OS) for gastric adenocarcinoma (GA)., Methods: Consecutive patients who underwent gastrectomy for GA were retrospectively evaluated. Univariate and multivariate models assessed determinants of OS., Results: From 1994 to 2015, 656 consecutive patients who underwent gastrectomy were evaluated. Briefly, 455 (69.4%) were male, 397 (60.5%) underwent total gastrectomy, Roux-en-Y reconstruction was done in 483 (73.6%), and R0 resection was achieved in 632 patients (96.3%). According to multivariate analysis, the risk of death was increased with older age (≥70-y), high-grade tumors, lesions ≥ 5 cm, positive nodes ≥ 3, and extra-gastric resections. Otherwise, D2 lymphadenectomy improved median OS (37 versus 16 months), 3-y (51.1 versus 32.2%), 5-y (43.2 versus 26), and 10-y OS (30.6 versus 9.4%), with HR of 0.48 (95% CI 0.34-0.67, p < 0.001). The general median OS was 31 months and 3-, 5-, and 10-y were 47.6, 40, and 27%, respectively. The median follow-up for all patients was 26 months, and for survivors was 65 months., Conclusion: This study showed D2 lymphadenectomy for GA as an independent prognostic factor for OS, even after 5-y and until 10-y. Our study suggests that D2 should be offered as the curative-intent treatment for all patients with GA that fit to undergo surgery., (Copyright © 2018 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)

Introduction: Surgical resection is a standard treatment for thymic malignancies. However, prognostic significance of nodal metastases and lymph node dissection remains unclear. The aim of this study is to determine prognostic significance of nodal metastases and the role of lymph node dissection (LND) in thymic malignancies., Methods: Between 2000 and 2013, 1597 patients who underwent thymectomy due to thymic malignancy were included. Predictive factors for nodal metastasis and prognostic significance of LND were evaluated. Patients were divided into two groups: (1) LND+ group, with intentional LND (446 patients, 27.9%); and (2) LND- group, without intentional LND (1151 patients, 72.1%). Propensity score matching was performed between the two groups., Results: Lymph node metastasis was identified in 20 (6.7%) of 298 patients with thymoma and 47 (31.7%) of 148 patients with thymic carcinoma. In multivariable analysis, thymic carcinoma (hazard ratio: 19.2, p < 0.001) and tumor size (hazard ratio: 1.09, p = 0.02) were significant predictive factors for lymph node metastasis. The 10-year freedom from recurrence rate of pN1 and pN2 was significantly worse than that of pN0 (p < 0.001). LND did not increase operative mortality or complication. There was no significant difference in 10-year freedom from recurrence rate between LND+ and LND- groups (82.4% versus 80.9%, p = 0.46 in thymoma; 45.7% versus 44.0%, p = 0.42 in thymic carcinoma)., Conclusions: Lymph node metastasis was a significant prognostic factor in thymic malignancies. Although LND did not improve long-term outcomes in thymic malignancies, LND played a role in accurate staging, and improved prediction of prognosis., (Copyright © 2018 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.)

Introduction > The role of cytoreductive nephrectomy (CN) in combination with targeted therapy has been debated after the results of the CARMENA trial. We decided to reassess the available evidence on the setting of CN in metastatic renal cell carcinoma (mRCC) patients. Methods > Critical review of the literature focusing on CN in mRCC patients. Results > Previous trials demonstrated a survival benefit of CN during the cytokine-era. In the targeted therapies-era, retrospective studies has confirmed the survival benefit of CN but presented inherent selection biases. Recently, the CARMENA trial showed that sunitinib alone was not inferior to CN plus sunitinib, and could be followed by subsequent CN in good-responders patients. CN is found to be a morbid surgery (perioperative mortality rate of 0-13% and major postoperative complications rate of 3-36%) and should be avoided in patients with primary refractory disease, using targeted therapy as a selection tool. Some parameters have been associated with shorter overall survival, leading to propose up-front CN only to patients with good performance status, a high-volume renal tumor and a low metastatic burden. Conclusions > While previous studies demonstrated a survival benefit of CN, the CARMENA trial showed that immediate CN was not necessary in some patients with mRCC, leading to a paradigm shift. Targeted therapy should be proposed as first line treatment, and the response to pre-surgical therapy could be used as a selection tool for subsequent decision of CN in good-responders patients., (© 2018 Société Française du Cancer. Publié par Elsevier Masson SAS. Tous droits réservés.)

Objectives: Although treatment paradigms have not changed significantly, radiotherapy, surgery, and imaging techniques have improved, leading us to investigate oncologic and survival outcomes for oral cavity squamous cell cancer (OCSCC) patients treated with surgery followed by postoperative IMRT., Material and Methods: Records of patients with pathological diagnosis of OCSCC treated between 2000 and 2012 were retrospectively reviewed. Patients' demographic, disease, and treatment criteria were extracted. Kaplan-Meier method was used to calculate survival curves., Results: Two hundred eighty-nine patients were analyzed. Median follow-up was 35months. Two hundred sixty-eight had neck dissections (93%), of which 66% had nodal involvement, and 51% of those positive dissections had extracapsular extension. Forty patients received induction chemotherapy and 107 received concurrent chemotherapy. Median dose to high risk clinical target volume was 60Gy/30 fractions. The 5-year locoregional control and overall survival rates were 76% and 57%, respectively. Tumors with >1.5cm depth of invasion had significantly higher risk of local failure compared with ≤1.5cm (p<0.001). In multivariate analysis, positive and no neck dissection (p=0.01), positive lymphovascular invasion (p=0.006) and >1.5cm depth of invasion (p=0.003) were independent predictors of poorer survival., Conclusions: Disease outcomes were consistent with historical data and did not appear compromised by the use of IMRT., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Introduction: The objective of the study was to compare oncologic outcomes and complications in patients with prostate cancer who underwent radical perineal prostatectomy (RPP), radical retropubic prostatectomy (RRP), laparoscopic radical prostatectomy (LRP), or robotic-assisted radical prostatectomy (RARP)., Materials and Methods: We retrospectively reviewed 2617 patients who underwent RPP (n = 673), RRP (n = 396), LRP (n = 223), or RARP (n = 1325) between 1995 and 2013. Clinicopathological outcomes were compared according to surgical approach. Kaplan-Meier and Cox regression analyses were carried out to assess oncologic outcomes. Complications were stratified according to the Clavien classification system., Results: The 5-year biochemical recurrence (BCR)-free survival after RPP was 75.3%, which was higher than for RRP (71.4%; P = .007) and comparable with LRP (76.1%; P = .666) and RARP (75.3%; P = .898). In multivariate analysis, RPP was comparable with LRP (P = .591) and RARP (P = .089) whereas RRP was associated with increased BCR (P < .001). No significant difference was seen in 5-year cancer-specific survival (RPP, 99.0%; RRP, 98.7%; LRP, 100.0%; and RARP, 99.8%; P = .071). The 5-year overall survival after RPP was 97.0%, which was lower than for RARP (99.6%; P = .007), but comparable with RRP (96.2%; P = .792) and LRP (99.1%; P = .606). Overall complication rates were 25.1% for RPP, 36.4% for RRP, 16.1% for LRP, and 9.4% for RARP (P < .001), respectively. After RPP, wound dehiscence (10.3%) was the most common complication. However, approximately 75% of complications were minor., Conclusion: RPP showed acceptable oncologic outcomes compared with other surgical approaches. Careful attention is required to prevent wound dehiscence., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Evidence suggests that redirecting surgeries to high-volume providers may be associated with better outcomes and significant societal savings. Whether such referrals are feasible remains unanswered., Methods: Medicare Provider Utilization and Payment Data, SEER 18, and US Incidence data were used to determine the geographic distribution and radical prostatectomy volume for providers. Access was defined as availability of a high-volume provider within driving distance of 100 miles. The opportunity cost was defined as the value of benefits achievable by performing the surgery by a high-volume provider that was forgone by not making a referral. The savings per referral were derived from a published Markov model for radical prostatectomy., Results: A total of 14% of providers performed>27% of the radical prostatectomies with>30 cases per year and were designated high-volume providers. Providers with below-median volume (≤16 prostatectomies per year) performed>32% of radical prostatectomies. At least 47% of these were within a 100-mile driving distance (median = 22 miles), and therefore had access to a high-volume provider (>30 prostatectomies per year). This translated into a discounted savings of more than $24 million per year, representing the opportunity cost of not making a referral. The average volume for high- and low-volume providers was 55 and 13, respectively, resulting in an annual experience gap of 43 and a cumulative gap of 125 surgeries over 3 years. In 2014, the number of surgeons performing radical prostatectomy decreased by 5% while the number of high- and low-volume providers decreased by 25% and 11% showing a faster decline in the number of high-volume providers compared with low-volume surgeons., Conclusions: About half of prostatectomies performed by surgeons with below-median annual volume were within a 100-mile driving distance (median of 22 miles) of a high-volume surgeon. Such a referral may result in minimal additional costs and substantially improved outcomes., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Given the increasing interest in the possible role of the neutrophil-to-lymphocyte ratio (NLR) as an easily available oncologic marker for upper tract urothelial cancer (UTUC), we sought to quantify the prognostic effect of this biomarker and assess its consistency in UTUC. A systematic review of the published data was performed up to May 2016 using multiple search engines (PubMed, Ovid, and Scopus) to identify eligible comparative studies. A formal meta-analysis was performed for studies comparing patients with a high and those with a low NLR before surgical treatment of UTUC to determine whether the NLR is an independent predictor of survival. Pooled estimates were calculated using a fixed-effects model if no significant heterogeneity was identified. Alternatively, a random-effects model was used when significant heterogeneity was detected. For continuous outcomes, the weighted mean difference was used as a summary measure. For binary variables, the odds ratio or risk ratio was calculated with the 95% confidence intervals (CIs). Statistical analyses were performed using RevMan, version 5. Six studies with 1710 patients were included. A high NLR was associated with poorer oncologic outcomes in patients affected by UTUC, in particular in terms of overall survival (hazard ratio [HR], 1.97; 95% CI, 1.27-3.04; P = .002) and recurrence-free survival (HR, 1.53; 95% CI, 1.19-1.96; P = .0009) but not cancer-specific survival (HR, 1.25; 95% CI, 0.29-5.41; P = .77). Current evidence suggests that the NLR might have an independent role as a prognostic factor in patients affected by UTUC undergoing surgical treatment. The NLR potentially represents an easily available measurement of prognosis; however, it requires validation in larger prospective studies., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Introduction: Lymph node dissection (LND) performed during radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC) remains controversial and difficult to evaluate. The aim of this study was to investigate whether removal of more lymph nodes during RNU is safe and improves oncologic outcomes., Methods: We evaluated 422 patients who underwent RNU with concomitant LND for upper tract urothelial carcinoma between 1976 and 2015, assessing for an association between total nodes removed, recurrence-free survival, and cancer-specific survival using Cox proportional hazards models. We also investigated the relationship between nodal yield and perioperative metrics and intersurgeon variability using linear regression., Results: In our cohort of 442 patients, 239 developed recurrences and 94 patients died of disease. Median follow-up among survivors was 3.7 years (interquartile range: 1.2, 7.4). The median nodal yield was 9 (interquartile range: 4, 16). Among patients with node-positive disease (pN1), we observed a significant improvement in recurrence-free survival (hazard ratio = 0.84 per 5 nodes removed, P = 0.039) and a nonsignificant improvement in cancer-specific survival with an increase in the nodal yield (hazard ratio = 0.90 per 5 nodes removed, P = 0.2). There was no evidence of an association between node yield and operative time, estimated blood loss, or 30-day complications on multivariable analysis. There was significant heterogeneity among surgeons regarding the extent of LND (P<0.0001)., Conclusions: We found that a more extensive node dissection may improve oncologic outcomes in a subset of high-risk patients without significantly increasing operative time or serious complications. Additionally, we identified considerable intersurgeon heterogeneity regarding the extent of LND furthering the notion of surgeon variability as a nonstandardized factor., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: To evaluate the oncologic outcomes of nephron-sparing surgery (NSS) for localized chromophobe renal cell carcinoma (cRCC)., Material and Methods: We performed a multicenter international study involving the French Network for Research on Kidney Cancer (UroCCR) and 5 international teams. Data from 808 patients treated with NSS between 2004 and 2014 for non-clear cell RCCs were analyzed., Results: We included 234 patients with cRCC. There were 123 (52.6%) females. Median age was 61 (23-88) years. Median tumor size was 3 (1-11)cm. A positive surgical margin was identified in 14 specimens (6%). Pathologic stages were T1, T2, and T3a in 202 (86.3%), 9 (3.8%), and 23 (9.8%) cases, respectively. After a mean follow-up of 46.6 ± 36 months, 2 (0.8%) patients experienced a local recurrence. No patient had metastatic progression, and no patient died from cancer. Three-years estimated cancer-free survival and cancer-specific survival were 99.1% and 100%, respectively., Conclusion: Oncological results of NSS for localized cRCC are excellent. In this series, only 2 patients had a local recurrence, and no patient had metastatic progression or died from cancer., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: The risk of unfavorable prostate cancer in active surveillance (AS) candidates is nonnegligible. However, what represents an adverse pathologic outcome in this setting is unknown. We aimed at assessing the optimal definition of misclassification and its effect on recurrence in AS candidates treated with radical prostatectomy (RP)., Materials and Methods: Overall, 1,710 patients eligible for AS according to Prostate Cancer Research International: Active Surveillance criteria treated with RP between 2000 and 2013 at 3 centers were evaluated. Patients were stratified according to pathology results at RP: organ-confined disease and pathologic Gleason score ≤ 6 (group 1); organ-confined disease and Gleason score 3+4 (group 2); and non-organ-confined disease, Gleason score ≥ 4+3, and nodal invasion (group 3). Biochemical recurrence (BCR) was defined as 2 consecutive prostate-specific antigen (PSA) ≥ 0.2 ng/ml. Kaplan-Meier curves assessed time to BCR. Multivariable Cox regression analyses tested the association between pathologic features and BCR. Multivariable logistic regression analyses identified the predictors of adverse pathologic characteristics., Results: Overall, 926 (54.2%), 653 (33.0%), and 220 (12.9%) patients were categorized in groups 1, 2, and 3, respectively. Median follow-up was 32.2 months. The 5-year BCR-free survival rate was 94.2%. Patients in group 3 had lower BCR-free survival rates compared with those in group 1 (79.1% vs. 97.0%, P<0.001). No differences were observed between patients included in group 1 vs. group 2 (97.0% vs. 94.7%, P = 0.1). These results were confirmed at multivariable analyses and after stratification according to margin status. Older age and PSA density ≥ 10 ng/ml/ml were associated with higher risk of unfavorable pathologic characteristics (i.e., inclusion in group 3; all P<0.001)., Conclusions: Among patients eligible for AS treated with RP, only men with Gleason score ≥ 4+3 or non-organ-confined disease at final pathology were at increased risk of BCR. These individuals represent the real misclassified AS patients, who can be predicted based on older age and higher PSA density., (Copyright © 2015 Elsevier Inc. All rights reserved.)