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Objective: Liposarcoma (LPS) is classified into 4 subtypes. As some subtypes have a high recurrence rate, knowing the risk of recurrence before surgery is important. Here, we aimed to investigate the relationship between Hounsfield units (HU) derived from preoperative computed tomography (CT) and the prognosis of patients undergoing surgery., Materials and Methods: We included 32 patients who underwent surgery for LPS between 2014 and 2022. Preoperative plain CT images were collected, and the HU value of each LPS was measured. The association between 2 HU categories (HU < cut-off vs. ≥ cut-off) and clinical variables was assessed. The optimal cut-off value was determined using statistical methods. We used the Kaplan-Meier method to determine the differences between the 2 HU categories at 2 endpoints: recurrence-free survival (RFS) and overall survival (OS)., Results: The dedifferentiated subtype showed significantly higher HU values than the other subtypes (P < .001). The optimal cut-off value for HU was 20. HU < 20 was associated with young age, low-performance status, low Charlson Comorbidity Index, and well-differentiated pathology. The Kaplan-Meier curves demonstrated that RFS and OS were significantly shorter in patients with HU ≥ 20 than in those with HU < 20 (P = .007 and .04, respectively). However, when stratified based on subtype, no significant differences were observed between dedifferentiated and other subtypes., Conclusion: HU ≥ 20 on preoperative CT was associated with poor prognosis in LPS patients. Our findings suggest that preoperative CT-derived HU values may serve as useful predictors of prognosis.

Introduction: There are often opportunities to consider treatment strategies for synchronous or metachronous prostate cancer with colorectal cancer. Performing robot-assisted radical prostatectomy for prostate cancer following previous rectal cancer surgery in cases involving anal-preserving surgeries such as low anterior resection or intersphincteric resection can be challenging because of the possibility of adhesions., Case Presentation: A 74-year-old man who had undergone laparoscopic intersphincteric resection for rectal cancer was diagnosed with prostate cancer. The patient desired to undergo robot-assisted radical prostatectomy. During surgery, we observed the absence of Denonvillier's fascia on the dorsal surface of the prostate, the intestinal anastomosis was distal to the vesicourethral anastomosis, and the rectum was replaced with a peristaltic sigmoid colon with minimal adhesions., Conclusion: Periprostatic conditions vary depending on previous rectal surgical approaches. It is crucial to confirm the previous surgical approach for rectal cancer when performing robot-assisted radical prostatectomy following rectal cancer surgery., Competing Interests: The authors declare that they have no conflict of interest., (© 2024 The Author(s). IJU Case Reports published by John Wiley & Sons Australia, Ltd on behalf of Japanese Urological Association.)

Objectives: We aimed to evaluate the association between scores on each item of the SARC-F questionnaire and life expectancy in patients undergoing major surgery for urologic cancer., Methods: This retrospective study included 1018 patients undergoing elective major urologic cancer surgery. All patients completed the SARC-F questionnaire preoperatively. Demographic and clinical data were collected. The primary endpoint was an association between SARC-F scores and overall survival (OS)., Results: Of the 1018 patients, the median age was 72 years and 920 (90%) were male. Multivariate analysis revealed four factors significantly and independently associated with shorter OS: assistance with walking score ≥1 (Hazard ratio: HR=2.18, P =0.044), cancer stages ≥ III (HR=7.98, P <0.001), high blood loss ≥78 ml or blood transfusion during surgery (HR=4.53, P =0.007 and HR=2.41, P =0.037, respectively)., Conclusions: This study found that among the items of the SARC-F questionnaire, assistance with walking was a strong predictor of life expectancy. Incorporating such a simple screening tool into the preoperative assessment would help to ensure more appropriate perioperative care for urologic cancer patients., (Copyright: © 2024 Hylonome Publications.)

Introduction: Treatment evidence for malignancies metastatic to the prostate in young patients is scarce. Herein, we present a case of prostatic metastasis from testicular cancer treated with induction chemotherapy followed by robot-assisted radical prostatectomy. Case Presentation. The patient is a 34-year-old male who underwent radical orchiectomy for a left testicular tumor two years ago and was diagnosed with a mixed germ cell tumor. He was followed up without adjuvant therapy, but symptoms of dysuria lead to suspicion of a prostate tumor, which was diagnosed by prostate biopsy as seminoma of the prostate. After four cycles of chemotherapy, normalization of tumor markers, and tumor shrinkage on imaging, he underwent robot-assisted radical prostatectomy. No recurrence has been observed nine months after treatment., Conclusion: In men with a history of testicular cancer presenting with lower urinary tract symptoms, it is important to consider recurrent prostate metastases., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2024 Kohei Hirose et al.)

Introduction: Sarcopenia is a condition of low muscle strength and quantity, severe if low physical performances. The sarcopenia index (SI), calculated by blood levels of creatinine and cystatin C, had been reported to be correlated with skeletal muscle mass and is a potential simple screening tool for sarcopenia. We hypothesized that patients with a low SI, meaning low muscle mass, would have an inflated estimated glomerular filtration rate (eGFR) value based on serum creatinine levels. We also tested the prognostic value of the SI in a cohort of patients who had surgery for renal malignancies., Patients and Methods: We conducted a retrospective, observational study of 322 patients that had surgery for renal tumors in National Cancer Center Hospital East (Kashiwa, Chiba) between April 2017 and June 2023. We assessed sarcopenia measuring psoas muscle index (PMI), psoas muscle density (PMD), and skeletal muscle area (SMA) by computed tomography. We assessed the association between SI and eGFR before and after surgery. We also assessed the association between SI and postoperative outcome, including overall survival., Results: Of the 322 patients, 211 (66%) were males, with a median age of 69 years. SI had a weak correlation with both PMI and PMD in males (PMI: ρ = 0.25; PMD: ρ = 0.21). In females, SI and PMD exhibited a low correlation (ρ = 0.26), while SI and PMI displayed an insignificant correlation (ρ = 0.19). The correlation between SMA and SI was moderate for both males and females (males: ρ = 0.51; females: ρ = 0.46). After radical nephrectomy, eGFR decreased in 98% of patients with high SI, compared to 69% of patients with low SI. We also demonstrated that low SI predicted poor prognosis., Conclusions: Clinicians can recognize the possibility of overestimated eGFR in the low SI group by measuring SI around the surgery. Low SI may also help predict poor prognosis., Competing Interests: Disclosures The authors declare that they have no competing interests., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: The Flemish version of the Triage Risk Screening Tool (fTRST), derived from the Triage Risk Screening Tool for assessing risk of readmission to the emergency department, is increasingly used as a simple screening tool in oncology. This study aimed to evaluate the utility of the fTRST in the context of elective surgical treatment for urologic cancer patients., Methods: We included 886 patients who underwent major urologic cancer surgery at our institution between 2020 and 2022 and underwent preoperative screening, including fTRST. We set the fTRST cutoff at 2 and used propensity score matching and multivariate regression analysis to assess how fTRST affected two postoperative outcomes: ambulation failure and delirium., Results: Of the 886 patients, 693 (78%) had an fTRST score <2, and 193 (22%) had an fTRST score ≥2 (high likelihood of frailty). After matching the groups by propensity scores, we compared the outcomes of 131 patients in each group. We found that the group with fTRST ≥2 had significantly higher rates of ambulation failure (15 vs. 11%, p = 0.03) and delirium (16 vs. 11%, p = 0.008) than the group with fTRST <2. Multivariate logistic regression analysis showed that fTRST score ≥2 was an independent risk factor for postoperative ambulation failure (odds ratio [OR] = 4.05, p = 0.02), along with age ≥75 years (OR = 6.62, p = 0.02), preoperative benzodiazepine medications (OR = 5.12, p = 0.01), and receiving radical cystectomy (OR = 9.30, p = 0.02). Similarly, for delirium, fTRST score ≥2 was an independent risk factor (OR = 2.88, p = 0.03), along with preoperative benzodiazepine medications (OR = 4.38, p = 0.002)., Conclusion: The fTRST might be a screening tool with great potential for identifying patients at high risk for unfavorable postoperative outcomes in elective urologic cancer surgery., Competing Interests: The authors have no conflicts of interest to declare., (© 2024 The Author(s). Published by S. Karger AG, Basel.)

Introduction: This study compared the clinical characteristics of patients who had hallucinations and those who did not during delirium after elective cancer surgery., Materials and Methods: This study retrospectively observed 1137 consecutive patients who had preoperative screening by a trained nurse before elective major urologic cancer surgery in our department. We compared the patient characteristics, including mini-cognitive assessment instrument (Mini-Cog) and Geriatric-8 (G8) scores, between those who developed postoperative delirium and those who did not, and also between those who had hallucinations and those who did not during delirium., Results: Out of 1137 patients, 68 developed postoperative delirium, and 12 of them had hallucinations. A hierarchical cluster analysis based on the G8 and Mini-Cog scores divided the patients into two groups: one with high G8 and cognitive function (36 patients) and one with low G8 and cognitive function (32 patients). Hallucinations during delirium were more frequent in the high G8 and cognitive function group (11 out of 36 patients) than in the low G8 and cognitive function group (one out of 32 patients). Patients who had hallucinations during delirium also had higher preoperative Mini-Cog scores (P = 0.002) and G8 scores (P = 0.03) than those who did not, indicating better cognitive function and less frailty., Discussions: We identified a patient population that is prone to hallucinations that preoperative screening tools cannot detect. This suggests the heterogeneity of postoperative delirium and the need for further research., Competing Interests: Declaration of competing interest The all authors have no conflict of interest to declare., (© 2024 Elsevier Ltd, BASO ∼ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)

Background: Participation in housework and meal preparation are instrumental activity of daily living (IADL) evaluation items that is known to predict prognosis and complications in cancer care. However, these items are often assessed only for females, not for males, in IADL., Methods: We examined the impact of habit of housework and meal preparation on overall survival (OS) in 1025 Japanese male patients who underwent elective urologic cancer surgery at our institution. The study also used a cohort that was matched by propensity score., Results: We found that patients who did not prepare meals or do housework had significantly shorter OS (hazard ratio [HR] = 3.34, P = 0.005; HR = 5.01, P < 0.001, respectively). Even in the cohort of 448 patients matched by propensity score and adjusted for age, body mass index, comorbidities, performance status, living status, cancer type, stage groups of cancer, and surgical approach, lack of participation in housework was associated with shorter OS (HR = 2.92, P = 0.04) and was an independent predictor of worse OS in multivariable analysis (HR = 5.13, P = 0.008)., Conclusions: Males who did not regularly do household chores before elective cancer surgery had worse life outcomes. Doing more daily physical activities, such as household chores like making the bed and cleaning the room, might have a positive impact on survival when fighting cancer., Competing Interests: Declaration of competing interest No authors have conflicts of interest to report., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: The aim of this study was to evaluate the features and benefits of different geriatric screening tools for enhancing the perioperative care of patients who undergo elective cancer surgery using cluster analysis., Methods: This study was a retrospective, observational analysis of 1,019 consecutive patients who had elective major cancer surgery in the urology department of our hospital from October 2019 to January 2023. Before the surgery, a trained nurse screened the patients using six tools: Eastern Clinical Oncology Group performance status (ECOG-PS), flemish version of the triage risk screening tool (fTRST), geriatric-8 (G8), instrumental activities of daily living, patient health questionnaire-2 (PHQ-2), and simple questionnaire to rapidly diagnose sarcopenia (SARC-F). The study grouped the patients into four clusters based on their scores on these tools and compared their outcomes after the surgery. The outcomes included overall survival, ambulation failure, delirium, and severe complications. The study also examined how each screening tool was associated with the outcomes., Results: Based on their clinical data and screening results, we classified the patients into four groups: Healthy (73%), Depressive (11%), Intermediate (11%), and Unhealthy (5%). The Unhealthy group had the worst outcomes in overall survival (OS), ambulation failure, and delirium, followed by the Intermediate group. In addition, fTRST and SARC-F emerged as significant predictors of OS; ECOG-PS, fTRST, G8, and SARC-F of ambulation failure; ECOG-PS, fTRST, and G8 of delirium; and G8 of severe complications., Conclusion: Various geriatric screening tools were found to have the potential to forecast diverse postoperative outcomes., (© 2024 S. Karger AG, Basel.)

A 42-year-oldman visited our hospital because of gradually worsening penile swelling over 3 weeks. A hard mass on the glans was palpated; however, we were unable to observe it due to severe phimosis. Magnetic resonance imaging of the pelvis revealed enlargement of glans and swelling of bilateral inguinal lymph nodes as both showed a low signal intensity on T2-weightedimaging, a high signal intensity on diffusion-weighted imaging, and a low signal intensity on the apparent diffusion coefficient map. Fluorine- 18-deoxyglucose (FDG) positron emission tomography showed FDG uptake at the external iliac, common iliac, obturator, and cervical lymph nodes besides the glans and inguinal lymph nodes. Although his serum squamous cell carcinoma antigen level was within the normal range, his soluble interleukin-2 receptor concentration was elevated to 2,290 U/ml. Therefore, we diagnosed these lesions as penile cancer with multiple lymph node metastases, with a possible differential diagnosis of malignant lymphoma. We planned a penile needle biopsy; however, the rapid plasma reagin test and treponema pallidum hemagglutination test, which were performed during the preoperative examination, were positive and led to a diagnosis of secondary syphilis. The patient was treated with oral amoxicillin at 1,500 mg/day for 8 weeks. The penile and lymph node swelling subsided after starting medication.