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2. Designing Remote Patient Monitoring Technologies for Post-operative Home Cancer Recovery: The Role of Reassurance

Author

Timinis, Constantinos, Opie, Jeremy, Watt, Simon, Khetrapal, Pramit, Kelly, John, Mavrikis, Manolis, Rogers, Yvonne, Drobnjak, Ivana, Goos, Gerhard, Founding Editor, Hartmanis, Juris, Founding Editor, Bertino, Elisa, Editorial Board Member, Gao, Wen, Editorial Board Member, Steffen, Bernhard, Editorial Board Member, Yung, Moti, Editorial Board Member, Abdelnour Nocera, José, editor, Kristín Lárusdóttir, Marta, editor, Petrie, Helen, editor, Piccinno, Antonio, editor, and Winckler, Marco, editor

Published
2023
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3. Measuring health status using wearable devices for patients undergoing radical cystectomy

Author

Khetrapal, Pramit

Abstract

Wearable devices (WDs) are an untapped resource for measuring patient health status during the peri-operative period. The overarching aim of this thesis is to explore the potential for WDs to be used in the clinical setting for patients undergoing radical cystectomy (RC) for bladder cancer. The lack of consensus regarding the optimal approach for RC presents an opportunity to design an RCT comparing open (ORC) and robotic (RARC) RC, in which a wearable device sub-study can be embedded. While the intracorporeal Robotic vs Open Cystectomy (iROC) trial will address the comparison between ORC and RARC, my thesis focuses on exploring the clinical utility of WDs. I present the results of a systematic review of RCTs comparing ORC and RARC. Meta-analysis shows no significant difference in peri-operative and oncological outcomes between ORC and RARC. Additionally, I systematically review healthcare studies using WDs and highlight the findings, device choices and device metrics used. Step-count is the most frequently collected WD metric, and chronic health conditions are the focus of majority of studies. Findings from these systematic reviews guided the design of the iROC trial protocol. I present the pre-planned interim analysis of the iROC trial, and explore associations between WD data and pre-operative health measures including cardiopulmonary exercise testing (CPET). Step-count correlates with the CPET variables (p < 0.01) routinely used to risk-stratify patients undergoing RC, and is the only predictor of major complications following RC in a logistic regression model. Finally, I evaluate recovery of baseline step-count at three months post-operatively as a predictor of overall survival. Applying a threshold of 50% recovery at 3 months, step-count predicts one-year survival to a sensitivity and specificity of 100% and 93% respectively. My findings highlight the potential of WDs in peri-operative care, and my post-doctoral work will progress this work further.

Published
2021

4. Robot-assisted Radical Cystectomy Versus Open Radical Cystectomy: A Systematic Review and Meta-analysis of Perioperative, Oncological, and Quality of Life Outcomes Using Randomized Controlled Trials

Author

Khetrapal, Pramit, Wong, Joanna Kae Ling, Tan, Wei Phin, Rupasinghe, Thiara, Tan, Wei Shen, Williams, Stephen B., Boorjian, Stephen A., Wijburg, Carl, Parekh, Dipen J., Wiklund, Peter, Vasdev, Nikhil, Khan, Muhammad Shamim, Guru, Khurshid A., Catto, James W.F., and Kelly, John D.

Published
2023
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5. PD36-04 REMOTE DIGITAL SURVEILLANCE AND MACHINE LEARNING MODELLING TO PREDICT SURVIVAL FOLLOWING RADICAL CYSTECTOMY FOR BLADDER CANCER—A SECONDARY OUTCOME ANALYSIS OF THE IROC TRIAL

Author

Khetrapal, Pramit, primary, Liu, Yansong, additional, Ambler, Gareth, additional, Williams, Norman R., additional, Sridhar, Ashwin, additional, Khan, Muhammad Shamim, additional, Ahmad, Imran, additional, Charlesworth, Philip, additional, Kotwal, Sanjeev, additional, Rowe, Edward, additional, Hanchanale, Vishwanath, additional, McGrath, John, additional, Vasdev, Nikhil, additional, Zhou, Yukun, additional, Catto, James W. F., additional, Ivana, Drobnjak, additional, and Kelly, John D., additional

Published
2024
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7. Corrigendum to “Robot-assisted Radical Cystectomy Versus Open Radical Cystectomy: A Systematic Review and Meta-analysis of Perioperative, Oncological, and Quality of Life Outcomes Using Randomized Controlled Trials” [Eur Urol. 2023;84:393–405]

Author

Khetrapal, Pramit, primary, Wong, Joanna Kae Ling, additional, Tan, Wei Phin, additional, Rupasinghe, Thiara, additional, Tan, Wei Shen, additional, Williams, Stephen B., additional, Boorjian, Stephen A., additional, Wijburg, Carl, additional, Parekh, Dipen J., additional, Wiklund, Peter, additional, Vasdev, Nikhil, additional, Khan, Muhammad Shamim, additional, Guru, Khurshid A., additional, Catto, James W.F., additional, and Kelly, John D., additional

Published
2023
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8. Digital Tracking of Patients Undergoing Radical Cystectomy for Bladder Cancer: Daily Step Counts Before and After Surgery Within the iROC Randomised Controlled Trial

Author

Khetrapal, Pramit, primary, Bains, Parasdeep S., additional, Jubber, Ibrahim, additional, Ambler, Gareth, additional, Williams, Norman R., additional, Brew-Graves, Chris, additional, Sridhar, Ashwin, additional, Ta, Anthony, additional, Kelly, John D., additional, and Catto, James W.F., additional

Published
2023
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12. PD36-12 MEASURING OBJECTIVE RECOVERY OF ACTIVITY LEVELS USING WEARABLE DEVICES FOLLOWING OPEN VS INTRACORPOREAL ROBOTIC CYSTECTOMY: SECONDARY OUTCOMES ANALYSIS OF THE IROC RANDOMIZED TRIAL

Author

Khetrapal, Pramit, primary, Catto, James, additional, Ambler, Gareth, additional, Williams, Norman, additional, Al-Hammouri, Tarek, additional, Khan, Muhammad Shamim, additional, Thurairaja, Ramesh, additional, Nair, Rajesh, additional, Nathan, Senthil, additional, Sridhar, Ashwin, additional, Ahmad, Imran, additional, Charlesworth, Philip, additional, Blick, Christopher, additional, Cumberbatch, Marcus, additional, Hussain, Syed, additional, Kotwal, Sanjeev, additional, Koupparis, Anthony, additional, Mcgrath, John, additional, Noon, Aidan, additional, Rowe, Edward, additional, Vasdev, Nikhil, additional, Bains, Parasdeep, additional, Hanchanale, Vishwanath, additional, and Kelly, John, additional

Published
2023
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13. Comparing biparametric to multiparametric MRI in the diagnosis of clinically significant prostate cancer in biopsy-naive men (PRIME): a prospective, international, multicentre, non-inferiority within-patient, diagnostic yield trial protocol

Author

Asif, Aqua, primary, Nathan, Arjun, additional, Ng, Alexander, additional, Khetrapal, Pramit, additional, Chan, Vinson Wai-Shun, additional, Giganti, Francesco, additional, Allen, Clare, additional, Freeman, Alex, additional, Punwani, Shonit, additional, Lorgelly, Paula, additional, Clarke, Caroline S, additional, Brew-Graves, Chris, additional, Muirhead, Nicola, additional, Emberton, Mark, additional, Agarwal, Ridhi, additional, Takwoingi, Yemisi, additional, Deeks, Jonathan J, additional, Moore, Caroline M, additional, and Kasivisvanathan, Veeru, additional

Published
2023
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14. Reply to Bernardo Rocco and Maria Chiara Sighinolfi’s Letter to the Editor re: James W.F. Catto, Pramit Khetrapal, Federico Ricciardi, et al. Effect of Robot-assisted Radical Cystectomy with Intracorporeal Urinary Diversion vs Open Radical Cystectomy on 90-Day Morbidity and Mortality Among Patients with Bladder Cancer: A Randomized Clinical Trial. JAMA 2022;327:2092–103

Author

Catto, James W.F., primary, Khetrapal, Pramit, additional, Ambler, Gareth, additional, Williams, Norman R., additional, Brew-Graves, Chris, additional, and Kelly, John D., additional

Published
2022
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17. Reply to Andreas Skolarikos’s Words of Wisdom re: Effect of Robot-assisted Radical Cystectomy with Intracorporeal Urinary Diversion vs Open Radical Cystectomy on 90-Day Morbidity and Mortality Among Patients with Bladder Cancer: A Randomized Clinical Trial. Eur Urol. In press

Author

Catto, James W.F., primary, Khetrapal, Pramit, additional, Ambler, Gareth, additional, Williams, Norman R., additional, Brew-Graves, Chris, additional, and Kelly, John D., additional

Published
2022
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18. It is PRIMEtime to streamline the prostate cancer MRIdiagnostic pathway

Author

Rossiter, Marimo, Khetrapal, Pramit, Ng, Alexander, Asif, Aqua, Nathan, Arjun, and Kasivisvanathan, Veeru

Abstract

A switch to pre‐biopsy multiparametric MRI as the first investigation in patients with a clinical suspicion of prostate cancer has resulted in capacity issues that may mean not all men will be tested in a timely manner. Biparametric MRI might produce similar results using fewer resources and thus help tackle the capacity issues. A new trial is designed to test whether the strategy could work.

Published
2023
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24. Setting up an emergency medical task force to manage the demands of COVID-19: experiences of a London teaching hospital

Author

Khetrapal, Pramit, primary, Skarbek, Sophie, additional, Tapper, Louis, additional, Mason, Claire, additional, Davis, Sarah, additional, Henderson, Daisy, additional, Riley, Ben, additional, Price, Liam, additional, Cumby, Charlotte, additional, Kennedy, Caroline, additional, Woodcock, Hannah, additional, Jain, Neel, additional, Ziser, Shier, additional, Yates, Timothy, additional, Mehta, Jay, additional, Amphlett, Alex, additional, Dinneen, Deirdre, additional, Aziz, Umaira, additional, Parekh, Vanisha, additional, Fernando, Bimbi, additional, Dilworth, Paul, additional, Jehangir, Amir, additional, Connolly, John, additional, Negus, Rupert, additional, Murch, Nick, additional, Molloy, Aoife, additional, Hui, Christopher, additional, and Burns, Aine, additional

Published
2021
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26. PD28-12 USING REMOTE MONITORING USING COMMERCIALLY AVAILABLE DEVICES TO PREDICT RE-ADMISSIONS FOR PATIENTS DISCHARGED FOLLOWING RADICAL CYSTECTOMY

Author

Khetrapal, Pramit, primary, Stafford, Ronnie, additional, Kocadag, Huriye, additional, Scanaill, Pádraig Ó, additional, Chang, Angela, additional, Hadjivasiliou, Adamos, additional, Liu, Yansong, additional, Gibbs, Olivia, additional, Pickford, Ellie, additional, Walker, David, additional, Drobnjak, Ivana, additional, and Kelly, John, additional

Published
2021
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27. Major Urological Cancer Surgery for Patients is Safe and Surgical Training Should Be Encouraged During the COVID-19 Pandemic: A Multicentre Analysis of 30-day Outcomes

Author

Tan, Wei Shen, Arianayagam, Rajan, Khetrapal, Pramit, Rowe, Edward, Kearley, Samantha, Mahrous, Ahmed, Pal, Raj, Fowler, William, Heer, Rakesh, Elajnaf, Mohamed, Douglas-Moore, Jayne, Leyshon Griffiths, T.R., Voss, James, Wilby, Daniel, Al Kadhi, Omar, Noel, Jonathan, Vasdev, Nikhil, McKay, Alastair, Ahmad, Imran, Abu-Nayla, Islam, Lamb, Benjamin, Hill, George T., Narahari, Krishna, Kynaston, Howard, Yousuf, Arzu, Kusuma, Venkata R.M., Cresswell, Jo, Cooke, Pete, Chakravarti, Aniruddha, Barod, Ravi, Bex, Axel, and Kelly, John D.

Published
2021
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28. Effect of Robot-Assisted Radical Cystectomy With Intracorporeal Urinary Diversion vs Open Radical Cystectomy on 90-Day Morbidity and Mortality Among Patients With Bladder Cancer

Author

Catto, James W. F., Khetrapal, Pramit, Ricciardi, Federico, Ambler, Gareth, Williams, Norman R., Al-Hammouri, Tarek, Khan, Muhammad Shamim, Thurairaja, Ramesh, Nair, Rajesh, Feber, Andrew, Dixon, Simon, Nathan, Senthil, Briggs, Tim, Sridhar, Ashwin, Ahmad, Imran, Bhatt, Jaimin, Charlesworth, Philip, Blick, Christopher, Cumberbatch, Marcus G., Hussain, Syed A., Kotwal, Sanjeev, Koupparis, Anthony, McGrath, John, Noon, Aidan P., Rowe, Edward, Vasdev, Nikhil, Hanchanale, Vishwanath, Hagan, Daryl, Brew-Graves, Chris, and Kelly, John D.

Subjects
Socioeconomic Factors, Humans, General Medicine, Practice Patterns, Physicians', Original Investigation
Abstract

IMPORTANCE: Robot-assisted radical cystectomy is being performed with increasing frequency, but it is unclear whether total intracorporeal surgery improves recovery compared with open radical cystectomy for bladder cancer. OBJECTIVES: To compare recovery and morbidity after robot-assisted radical cystectomy with intracorporeal reconstruction vs open radical cystectomy. DESIGN, SETTING, AND PARTICIPANTS: Randomized clinical trial of patients with nonmetastatic bladder cancer recruited at 9 sites in the UK, from March 2017-March 2020. Follow-up was conducted at 90 days, 6 months, and 12 months, with final follow-up on September 23, 2021. INTERVENTIONS: Participants were randomized to receive robot-assisted radical cystectomy with intracorporeal reconstruction (n = 169) or open radical cystectomy (n = 169). MAIN OUTCOMES AND MEASURES: The primary outcome was the number of days alive and out of the hospital within 90 days of surgery. There were 20 secondary outcomes, including complications, quality of life, disability, stamina, activity levels, and survival. Analyses were adjusted for the type of diversion and center. RESULTS: Among 338 randomized participants, 317 underwent radical cystectomy (mean age, 69 years; 67 women [21%]; 107 [34%] received neoadjuvant chemotherapy; 282 [89%] underwent ileal conduit reconstruction); the primary outcome was analyzed in 305 (96%). The median number of days alive and out of the hospital within 90 days of surgery was 82 (IQR, 76-84) for patients undergoing robotic surgery vs 80 (IQR, 72-83) for open surgery (adjusted difference, 2.2 days [95% CI, 0.50-3.85]; P = .01). Thromboembolic complications (1.9% vs 8.3%; difference, –6.5% [95% CI, –11.4% to –1.4%]) and wound complications (5.6% vs 16.0%; difference, –11.7% [95% CI, –18.6% to –4.6%]) were less common with robotic surgery than open surgery. Participants undergoing open surgery reported worse quality of life vs robotic surgery at 5 weeks (difference in mean European Quality of Life 5-Dimension, 5-Level instrument scores, –0.07 [95% CI, –0.11 to –0.03]; P = .003) and greater disability at 5 weeks (difference in World Health Organization Disability Assessment Schedule 2.0 scores, 0.48 [95% CI, 0.15-0.73]; P = .003) and at 12 weeks (difference in WHODAS 2.0 scores, 0.38 [95% CI, 0.09-0.68]; P = .01); the differences were not significant after 12 weeks. There were no statistically significant differences in cancer recurrence (29/161 [18%] vs 25/156 [16%] after robotic and open surgery, respectively) and overall mortality (23/161 [14.3%] vs 23/156 [14.7%]), respectively) at median follow-up of 18.4 months (IQR, 12.8-21.1). CONCLUSIONS AND RELEVANCE: Among patients with nonmetastatic bladder cancer undergoing radical cystectomy, treatment with robot-assisted radical cystectomy with intracorporeal urinary diversion vs open radical cystectomy resulted in a statistically significant increase in days alive and out of the hospital over 90 days. However, the clinical importance of these findings remains uncertain. TRIAL REGISTRATION: ISRCTN Identifier: ISRCTN13680280; ClinicalTrials.gov Identifier: NCT03049410

Published
2022

31. Recovery of health‐related quality of life in patients undergoing robot‐assisted radical cystectomy with intracorporeal diversion

Author

Abozaid, Mohammed, primary, Tan, Wei Shen, additional, Khetrapal, Pramit, additional, Baker, Hilary, additional, Duncan, Jacqueline, additional, Sridhar, Ashwin, additional, Briggs, Tim, additional, Selim, Mohamed, additional, Abdallah, Mohamed Marzouk, additional, Elmahdy, Alaa Aldin, additional, Elserafy, Fatma, additional, and Kelly, John D., additional

Published
2021
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32. Domiciliary recovery after medicalization pathway (DREAMPath): a protocol for a prospective observational study to measure patient compliance with remote monitoring following discharge from hospital after major surgery. (Preprint)

Author

Khetrapal, Pramit, primary, Stafford, Ronnie, additional, Ó Scanaill, Pádraig, additional, Kocadog, Huriye, additional, Timinis, Constantinos, additional, Chang, Angela, additional, Hadjivasiliou, Adamos, additional, Liu, Yansong, additional, Gibbs, Olivia, additional, Pickford, Ellie, additional, Walker, David, additional, Baker, Hilary, additional, Duncan, Jacqueline, additional, Tan, Melanie, additional, Williams, Norman, additional, Catto, James W.F., additional, Drobnjak, Ivana, additional, and Kelly, John D., additional

Published
2021
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33. Does urinary cytology have a role in haematuria investigations?

Author

Tan, Wei Shen, Sarpong, Rachael, Khetrapal, Pramit, Rodney, Simon, Mostafid, Hugh, Cresswell, Joanne, Watson, Dawn, Rane, Abhay, Hicks, James, Hellawell, Giles, Davies, Melissa, Srirangam, Shalom J., Dawson, Louise, Payne, David, Williams, Norman, Brew‐Graves, Chris, Feber, Andrew, and Kelly, John D.

Subjects
Male, Urological Oncology, diagnosis, Urine, urologic and male genital diseases, #blcsm, Predictive Value of Tests, Humans, False Positive Reactions, Prospective Studies, False Negative Reactions, Aged, Hematuria, Neoplasm Staging, Ultrasonography, Carcinoma, Transitional Cell, Ureteral Neoplasms, #BladderCancer, Urography, Middle Aged, Kidney Neoplasms, haematuria, investigations, Urinary Bladder Neoplasms, #utuc, cytology, biomarker, Female, Neoplasm Grading, Tomography, X-Ray Computed
Abstract

Objectives To determine the diagnostic accuracy of urinary cytology to diagnose bladder cancer and upper tract urothelial cancer (UTUC) as well as the outcome of patients with a positive urine cytology and normal haematuria investigations in patients in a multicentre prospective observational study of patients investigated for haematuria. Patient and methods The DETECT I study (clinicaltrials.gov NCT02676180) recruited patients presenting with haematuria following referral to secondary case at 40 hospitals. All patients had a cystoscopy and upper tract imaging (renal bladder ultrasound [RBUS] and/ or CT urogram [CTU]). Patients, where urine cytology were performed, were sub‐analysed. The reference standard for the diagnosis of bladder cancer and UTUC was histological confirmation of cancer. A positive urine cytology was defined as a urine cytology suspicious for neoplastic cells or atypical cells. Results Of the 3 556 patients recruited, urine cytology was performed in 567 (15.9%) patients from nine hospitals. Median time between positive urine cytology and endoscopic tumour resection was 27 (IQR: 21.3–33.8) days. Bladder cancer was diagnosed in 39 (6.9%) patients and UTUC in 8 (1.4%) patients. The accuracy of urinary cytology for the diagnosis of bladder cancer and UTUC was: sensitivity 43.5%, specificity 95.7%, positive predictive value (PPV) 47.6% and negative predictive value (NPV) 94.9%. A total of 21 bladder cancers and 5 UTUC were missed. Bladder cancers missed according to grade and stage were as follows: 4 (19%) were ≥ pT2, 2 (9.5%) were G3 pT1, 10 (47.6%) were G3/2 pTa and 5 (23.8%) were G1 pTa. High‐risk cancer was confirmed in 8 (38%) patients. There was a marginal improvement in sensitivity (57.7%) for high‐risk cancers. When urine cytology was combined with imaging, the diagnostic performance improved with CTU (sensitivity 90.2%, specificity 94.9%) superior to RBUS (sensitivity 66.7%, specificity 96.7%). False positive cytology results were confirmed in 22 patients, of which 12 (54.5%) had further invasive tests and 5 (22.7%) had a repeat cytology. No cancer was identified in these patients during follow‐up. Conclusions Urine cytology will miss a significant number of muscle‐invasive bladder cancer and high‐risk disease. Our results suggest that urine cytology should not be routinely performed as part of haematuria investigations. The role of urine cytology in select cases should be considered in the context of the impact of a false positive result leading to further potentially invasive tests conducted under general anaesthesia.

Published
2018

34. Measuring Patient Compliance With Remote Monitoring Following Discharge From Hospital After Major Surgery (DREAMPath): Protocol for a Prospective Observational Study.

Author

Khetrapal, Pramit, Stafford, Ronnie, Scanaill, Pádraig Ó., Kocadag, Huriye, Timinis, Constantinos, Chang, Angela H. L., Hadjivasiliou, Adamos, Yansong Liu, Gibbs, Olivia, Pickford, Eleanor, Walker, David, Baker, Hilary, Duncan, Jacqueline, Tan, Melanie, Williams, Norman, Catto, James, Drobnjak, Ivana, and Kelly, John

Subjects
HOSPITAL admission & discharge, SMARTWATCHES, BLUETOOTH technology, WEARABLE technology, HOSPITAL care
Abstract

Background: The incidence of major surgery is on the rise globally, and more than 20% of patients are readmitted to hospital following discharge from hospital. During their hospital stay, patients are monitored for early detection of clinical deterioration, which includes regularly measuring physiological parameters such as blood pressure, heart rate, respiratory rate, temperature, and pulse oximetry. This monitoring ceases upon hospital discharge, as patients are deemed clinically stable. Monitoring after discharge is relevant to detect adverse events occurring in the home setting and can be made possible through the development of digital technologies and mobile networks. Smartwatches and other technological devices allow patients to self-measure physiological parameters in the home setting, and Bluetooth connectivity can facilitate the automatic collection and transfer of this data to a secure server with minimal input from the patient. Objective: This paper presents the protocol for the DREAMPath (Domiciliary Recovery After Medicalization Pathway) study, which aims to measure compliance with a multidevice remote monitoring kit after discharge from hospital following major surgery. Methods: DREAMPath is a single-center, prospective, observational, cohort study, comprising 30 patients undergoing major intracavity surgery. The primary outcome is to assess patient compliance with wearable and interactive smart technology in the first 30 days following discharge from hospital after major surgery. Secondary outcomes will explore the relation between unplanned health care events and physiological data collected in the study, as well as to explore a similar relationship with daily patient-reported outcome measures (Quality of Recovery-15 score). Secondary outcomes will be analyzed using appropriate regression methods. Cardiopulmonary exercise testing data will also be collected to assess correlations with wearable device data. Results: Recruitment was halted due to COVID-19 restrictions and will progress once research staff are back from redeployment. We expect that the study will be completed in the first quarter of 2022. Conclusions: Digital health solutions have been recently made possible due to technological advances, but urgency in rollout has been expedited due to COVID-19. The DREAMPath study will inform readers about the feasibility of remote monitoring for a patient group that is at an increased risk of acute deterioration. Trial Registration: ISRCTN Registry ISRCTN62293620; https://www.isrctn.com/ISRCTN62293620 International Registered Report Identifier (IRRID): DERR1-10.2196/30638 [ABSTRACT FROM AUTHOR]

Published
2022
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36. MP61-06 THE ROLE OF WEARABLE DEVICES AND CPET IN PREDICTING MAJOR COMPLICATIONS AFTER RADICAL CYSTECTOMY

Author

Khetrapal*, Pramit, primary, Catto, James, additional, Norman, Williams, additional, Ambler, Gareth, additional, Sarpong, Rachael, additional, Khan, Muhammed Shamim, additional, Thurairaja, Ramesh, additional, Tan, Melanie, additional, Feber, Andrew, additional, Dixon, Simon, additional, Goodwin, Louise, additional, McGrath, John, additional, Charlesworth, Philip, additional, Rowe, Edward, additional, Koupparis, Anthony, additional, Brew-Graves, Chris, additional, and Kelly, John, additional

Published
2020
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37. Recovery of health‐related quality of life in patients undergoing robot‐assisted radical cystectomy with intracorporeal diversion.

Author

Abozaid, Mohammed, Tan, Wei Shen, Khetrapal, Pramit, Baker, Hilary, Duncan, Jacqueline, Sridhar, Ashwin, Briggs, Tim, Selim, Mohamed, Abdallah, Mohamed Marzouk, Elmahdy, Alaa Aldin, Elserafy, Fatma, and Kelly, John D.

Subjects
URINARY diversion, QUALITY of life, CYSTECTOMY, SURGICAL robots, SURGICAL complications, PHYSICAL mobility
Abstract

Objective: To report the health‐related quality of life (HRQoL) after robot‐assisted radical cystectomy and intracorporeal urinary diversion (iRARC), and to identify factors impacting on return to baseline. Patients and Methods: Consecutive patients undergoing iRARC between January 2016 and December 2017 completed the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire 30‐item core (EORTC‐QLQ‐C30) and EORTC‐QLQ‐Muscle‐Invasive Bladder Cancer Module (EORTC‐QLQ‐BLM30) questionnaires before surgery and had a minimum of 12 months follow‐up postoperatively. Results: A total of 76 patients met the inclusion criteria at 12 months. Neobladder (NB) cases (n = 24) were younger (57.0 vs 71.0 years, P < 0.001) and fitter than ileal conduit (IC) cases (n = 52), and had higher physical (100.0 vs 93.3, P = 0.039) and sexual functioning (66.7 vs 50.0, P = 0.013) scores at baseline. Longitudinal analysis of the EORTC‐QLQ‐C30 showed that physical (NB: 93.3 vs 100.0, P = 0.020; IC: 80.0 vs 93.3, P < 0.001) and role functioning scores (NB: 83.3 vs 100.0, P = 0.010; IC: 83.3 vs 100.0, P = 0.017) decreased and fatigue score (NB: 22.2 vs 11.1, P = 0.026; IC: 33.3 vs 22.2, P = 0.008) increased at 3 months in both diversion groups. Scores returned to baseline at 6 months except physical functioning score in IC patients that remained below baseline until 12 months (86.7 vs 93.3, P = 0.012). The global HRQoL score did not show significant change postoperatively in both groups. A major 90‐day Clavien–Dindo complication was a significant predictor (odds ratio [OR] 0.11, 95% confidence interval [CI] 0.02–0.62; P = 0.012) of deteriorated global HRQoL score at 3 months, while occurrence of a late complication (OR 0.14, 95% CI 0.03–0.65; P = 0.013) was a predictor of deteriorated global HRQoL score at 12 months. Longitudinal analysis of the EORTC‐QLQ‐BLM30 showed that urinary problems (NB: 14.3 vs 38.3, P < 0.001; IC: 5.6 vs 19.1, P < 0.001) and future perspective (NB: 33.3 vs 44.4, P = 0.004; IC: 22.2 vs 44.4, P < 0.001) scores were better than baseline at 3 months. Sexual function deteriorated significantly at 3 months (NB: 8.3 vs 66.7, P < 0.001; IC: 4.2 vs 50.0, P < 0.001) and then showed improvement at 12 months but was still below baseline (NB: 33.3 vs 66.7, P = 0.001; IC: 25.0 vs 50.0, P < 0.001). Involvement in penile rehabilitation was shown to be a significant predictor (β 18.62, 95% CI 6.06–30.45; P = 0.005) of higher sexual function score at 12 months. Conclusion: While most functional domains and symptoms scales recover to or exceed baseline within 6 months of iRARC, physical function remains below baseline in IC patients up to 12 months. Global HRQoL is preserved for both types of urinary diversion; however, postoperative complications seem to be the main driving factor for global HRQoL. Sexual function is adversely affected after iRARC suggesting that structured rehabilitation of sexual function should be an integral part of the RC pathway. [ABSTRACT FROM AUTHOR]

Published
2022
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39. Pathological Findings and Magnetic Resonance Imaging Concordance at Salvage Radical Prostatectomy for Local Recurrence following Partial Ablation Using High Intensity Focused Ultrasound

Author

Thompson, James Edward, primary, Sridhar, Ashwin N., additional, Tan, Wei Shen, additional, Freeman, Alex, additional, Haider, Aiman, additional, Allen, Clare, additional, Moore, Caroline M., additional, Orczyk, Clement, additional, Mazzon, Giorgio, additional, Khetrapal, Pramit, additional, Shaw, Greg, additional, Rajan, Prabhakar, additional, Mohammed, Anna, additional, Briggs, Timothy P., additional, Nathan, Senthil, additional, Kelly, John D., additional, and Sooriakumaran, Prasanna, additional

Published
2019
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42. DETECT I & DETECT II: a study protocol for a prospective multicentre observational study to validate the UroMark assay for the detection of bladder cancer from urinary cells

Author

Tan, Wei Shen, Feber, Andrew, Dong, Liqin, Sarpong, Rachael, Rezaee, Sheida, Rodney, Simon, Khetrapal, Pramit, de Winter, Patricia, Ocampo, Frelyn, Jalil, Rumana, Williams, Norman R., Brew-Graves, Chris, and Kelly, John D.

Subjects
Male, Surveillance, Bladder cancer, Liquid Biopsy, lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens, lcsh:RC254-282, Methylation, Clinical trial, Study Protocol, Urinary assay, Clinical Protocols, Urinary Bladder Neoplasms, Urinary biomarker, Next generation sequencing, Validation, Biomarkers, Tumor, Humans, Female, Diagnostic, Prospective Studies, Haematuria
Abstract

Background Haematuria is a common finding in general practice which requires visual inspection of the bladder by cystoscopy as well as upper tract imaging. In addition, patients with non-muscle invasive bladder cancer (NMIBC) often require surveillance cystoscopy as often as three monthly depending on disease risk. However, cystoscopy is an invasive procedure which is uncomfortable, requires hospital attendance and is associated with a risk of urinary tract infection. We have developed the UroMark assay, which can detect 150 methylation specific alteration specific to bladder cancer using DNA from urinary sediment cells. Methods DETECT I and DETECT II are two multi-centre prospective observational studies designed to conduct a robust validation of the UroMark assay. DETECT I will recruit patients having diagnostic investigations for haematuria to determine the negative predictive value of the UroMark to rule out the presence of bladder cancer. DETECT II will recruit patients with new or recurrent bladder cancer to determine the sensitivity of the UroMark in detecting low, intermediate and high grade bladder cancer. NMIBC patients in DETECT II will be followed up with three monthly urine sample collection for 24 months while having surveillance cystoscopy. DETECT II will include a qualitative analysis of semi-structured interviews to explore patients’ experience of being diagnosed with bladder cancer and having cystoscopy and a urinary test for bladder cancer surveillance. Results of the UroMark will be compared to cystoscopy findings and histopathological results in patients with bladder cancer. Discussion A sensitive and specific urinary biomarker will revolutionise the haematuria diagnostic pathway and surveillance strategies for NMIBC patients. None of the six approved US Food and Drug Administration urinary test are recommended as a standalone test. The UroMark assay is based on next generation sequencing technology which interrogates 150 loci and represents a step change compared to other biomarker panels. This enhances the sensitivity of the test and by using a random forest classifier approach, where the UroMark results are derived from a cut off generated from known outcomes of previous samples, addresses many shortcomings of previous assays. Trial registration Both trails are registered on clinicaltrials.gov. DETECT I: NCT02676180 (18th December 2015). DETECT II: NCT02781428 (11th May 2016).

Published
2017

44. Multidomain Quantitative Recovery Following Radical Cystectomy for Patients Within the Robot-assisted Radical Cystectomy with Intracorporeal Urinary Diversion Versus Open Radical Cystectomy Randomised Controlled Trial: The First 30 Patients

Author

Catto, James W.F., primary, Khetrapal, Pramit, additional, Ambler, Gareth, additional, Sarpong, Rachael, additional, Potyka, Ingrid, additional, Khan, Muhammad Shamim, additional, Tan, Melanie, additional, Feber, Andrew, additional, Bourke, Liam, additional, Noon, Aidan P., additional, Dixon, Simon, additional, Goodwin, Louise, additional, Williams, Norman R., additional, Rowe, Edward, additional, Kouparis, Anthony, additional, McGrath, John, additional, Brew-Graves, Chris, additional, and Kelly, John D., additional

Published
2018
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45. Urine-derived lymphocytes as a non-invasive measure of the bladder tumor immune microenvironment

Author

Wong, Yien Ning Sophia, primary, Joshi, Kroopa, additional, Khetrapal, Pramit, additional, Ismail, Mazlina, additional, Reading, James L., additional, Sunderland, Mariana Werner, additional, Georgiou, Andrew, additional, Furness, Andrew J.S., additional, Ben Aissa, Assma, additional, Ghorani, Ehsan, additional, Oakes, Theres, additional, Uddin, Imran, additional, Tan, Wei Shen, additional, Feber, Andrew, additional, McGovern, Ursula, additional, Swanton, Charles, additional, Freeman, Alex, additional, Marafioti, Teresa, additional, Briggs, Timothy P., additional, Kelly, John D., additional, Powles, Thomas, additional, Peggs, Karl S., additional, Chain, Benjamin M., additional, Linch, Mark D., additional, and Quezada, Sergio A., additional

Published
2018
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47. Robot-assisted radical cystectomy with intracorporeal urinary diversion versus open radical cystectomy (iROC): protocol for a randomised controlled trial with internal feasibility study

Author

Catto, James W F, primary, Khetrapal, Pramit, additional, Ambler, Gareth, additional, Sarpong, Rachael, additional, Khan, Muhammad Shamim, additional, Tan, Melanie, additional, Feber, Andrew, additional, Dixon, Simon, additional, Goodwin, Louise, additional, Williams, Norman R, additional, McGrath, John, additional, Rowe, Edward, additional, Koupparis, Anthony, additional, Brew-Graves, Chris, additional, and Kelly, John D, additional

Published
2018
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48. Who Should Be Investigated for Haematuria? Results of a Contemporary Prospective Observational Study of 3556 Patients

Author

Tan, Wei Shen, primary, Feber, Andrew, additional, Sarpong, Rachael, additional, Khetrapal, Pramit, additional, Rodney, Simon, additional, Jalil, Rumana, additional, Mostafid, Hugh, additional, Cresswell, Joanne, additional, Hicks, James, additional, Rane, Abhay, additional, Henderson, Alastair, additional, Watson, Dawn, additional, Cherian, Jacob, additional, Williams, Norman, additional, Brew-Graves, Chris, additional, and Kelly, John D., additional

Published
2018
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50. MP71-18 THE USE OF FITNESS TRACKER IN MONITORING FUNCTIONAL ACTIVITY OF PATIENTS UNDERGOING RADICAL CYSTECTOMY FOR BLADDER CANCER: A FEASIBILITY REPORT AND ANALYSIS AS PART OF THE MULTI-CENTRE RANDOMISED IROC TRIAL

Author

Khetrapal, Pramit, primary, Williams, Norman, additional, Tan, Melanie, additional, Feber, Andrew, additional, Ambler, Gareth, additional, Sarpong, Rachael, additional, Khan, Shamim, additional, Dixon, Simon, additional, Goodwin, Louise, additional, McGrath, John, additional, Rowe, Edward, additional, Koupparis, Anthony, additional, Brew-Graves, Chris, additional, Catto, James, additional, and Kelly, John, additional

Published
2018
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