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- Moschini, M, et al.
(författare)
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Open Versus Robotic Cystectomy: A Propensity Score Matched Analysis Comparing Survival Outcomes
- 2019
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Ingår i: Journal of clinical medicine. - : MDPI AG. - 2077-0383. ; 8:8
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Tidskriftsartikel (refereegranskat)abstract
- Background: To assess the differential effect of robotic assisted radical cystectomy (RARC) versus open radical cystectomy (ORC) on survival outcomes in matched analyses performed on a large multicentric cohort. Methods: The study included 9757 patients with urothelial bladder cancer (BCa) treated in a consecutive manner at each of 25 institutions. All patients underwent radical cystectomy with bilateral pelvic lymphadenectomy. To adjust for potential selection bias, propensity score matching 2:1 was performed with two ORC patients matched to one RARC patient. The propensity-matched cohort included 1374 patients. Multivariable competing risk analyses accounting for death of other causes, tested association of surgical technique with recurrence and cancer specific mortality (CSM), before and after propensity score matching. Results: Overall, 767 (7.8%) patients underwent RARC and 8990 (92.2%) ORC. The median follow-up before and after propensity matching was 81 and 102 months, respectively. In the overall population, the 3-year recurrence rates and CSM were 37% vs. 26% and 34% vs. 24% for ORC vs. RARC (all p values > 0.1), respectively. On multivariable Cox regression analyses, RARC and ORC had similar recurrence and CSM rates before and after matching (all p values > 0.1). Conclusions: Patients treated with RARC and ORC have similar survival outcomes. This data is helpful in consulting patients until long term survival outcomes of level one evidence is available.
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- Dindyal, S, et al.
(författare)
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Neonatal white leg: a case of anatomical misjudgment
- 2008
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Ingår i: British journal of hospital medicine (London, England : 2005). - : Mark Allen Group. - 1750-8460 .- 1759-7390. ; 69:9, s. 532-533
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Tidskriftsartikel (refereegranskat)
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- Sooriakumaran, P, et al.
(författare)
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A meta-analysis comparing positive surgical margin and complication rates of 110,016 patients undergoing open retropubic, laparoscopic, and robotic-assisted radical prostatectomy
- 2011
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Ingår i: JOURNAL OF CLINICAL ONCOLOGY. - : American Society of Clinical Oncology (ASCO). - 0732-183X .- 1527-7755. ; 29:7
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- 103 Background: There is no clear evidence to support one form of surgical approach over another with regards radical prostatectomy. The aim of this study was to analyze the literature available between 2002 and 2008 and compare positive surgical margin and complication rates for open retropubic, laparoscopic, and robotic radical prostatectomy. Methods: A total of 110,016 patients formed the basis of this meta-analysis, representing the largest compilation of radical prostatectomy patients in the literature. Summary data were abstracted on year of publication, pre-operative patient characteristics, positive surgical margins, estimated blood loss, blood transfusions, conversions, length of hospital stay, and total intra- and peri-operative complications, with a further 21 individual perioperative complications selected a priori for abstraction and analysis. Results: The open and laparoscopic surgical groups had similar overall positive surgical margin rates, with the robotic group having lower rates. Both minimally invasive approaches showed significantly lower estimated blood loss and rate of blood transfusions, and a shorter length of hospital stay when compared to an open approach. A further decrease in these parameters was seen when robotic assistance was used. Total complication rates were highest for the open approach, intermediate for the laparoscopic cohort, and lowest for the robotic group. For the individual complication analysis, the rates for death, readmission, reoperation, ureteral, bladder, and rectal injury, ileus, pneumonia, fistula, and wound infection showed significant differences between groups. Conclusions: Robotic assisted laparoscopic radical prostatectomy has overall lower perioperative morbidity and improved early oncologic outcomes compared to conventional laparoscopic or open approaches. Further studies comparing longer term oncologic and functional outcomes, as well as cost-benefit comparisons are needed before making recommendations for or against a specific type of surgery. [Table: see text]
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- Sooriakumaran, P, et al.
(författare)
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A multi-institutional study of 3,794 patients undergoing robotic-assisted laparoscopic radical prostatectomy to determine the surgical learning curve for positive margins and operating time
- 2011
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Ingår i: JOURNAL OF CLINICAL ONCOLOGY. - : American Society of Clinical Oncology (ASCO). - 0732-183X .- 1527-7755. ; 29:7
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- 102 Background: The surgical learning curve for robotic assisted laparoscopic radical prostatectomy (RALP) is often cited as being shorter than for other surgical modalities. However, while this appears true with regards to surgical safety, the learning curve for more refined variables like positive surgical margin (PSM) rate and operative time (OT) is not well established. Our objective was to assess the surgical learning curve for RALP in terms of these parameters. Methods: We performed a retrospective cohort study of 3,794 patients who underwent RALP between Jan 2003 and Sep 2009 by three surgeons (DL, PW, AKT) from three centers (UPenn, Karolinska, Cornell). Mean overall PSM rates and mean overall OT were calculated for all three surgeons at intervals of 50 RALPs per surgeon, and learning curves for these means were fit using a loess method. R version 2.71 was used for all statistical analysis. Results: The learning curve for PSM rates for all patients demonstrated improvements that continued with greater surgeon experience, with over 1,600 cases required to get a PSM rate <10%. When only pT3 patients were evaluated, the learning curve started to plateau after 1,000-1,500 cases. Mean OT plateaued after 750 cases although with further surgical experience the OTs started to climb again. Conclusions: The learning curve for RALP is not as short as previously thought, and a large number of cases are needed to get PSM rates and OTs to a minimum. This suggests that RALP should be performed by high volume surgeons in order to optimize patient outcomes. [Table: see text]
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- Sooriakumaran, P, et al.
(författare)
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A novel method of obtaining prostate tissue for gene expression profiling
- 2009
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Ingår i: International journal of surgical pathology. - : SAGE Publications. - 1066-8969 .- 1940-2465. ; 17:3, s. 238-243
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Tidskriftsartikel (refereegranskat)abstract
- Gene expression profiling by DNA microarray analysis is a technique with great promise in cancer biology. The multifocality and heterogeneity of many prostate cancers makes the collection of adequate biological samples for such profiling particularly challenging. Current methods, such as laser capture microdissection, are not widely available and can have significant limitations. In this article, a novel method of prostatic sampling, which does not affect the histopathological assessment of the surgical specimen and provides adequate RNA yield for microarray analysis is described. This method is simple, inexpensive, easily reproducible, and has been validated as having >95% sensitivity and 99% specificity for histological prediction of tissue obtained. This method can be adopted by other investigators to perform DNA microarray analysis on prostate tumors.
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- Sooriakumaran, P, et al.
(författare)
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Authors' reply to Roach
- 2014
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Ingår i: BMJ (Clinical research ed.). - : BMJ. - 1756-1833. ; 348, s. g2271-
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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- Sooriakumaran, P, et al.
(författare)
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Predictive Factors for Time to Progression after Hyperthermic Mitomycin C Treatment for High-Risk Non-Muscle Invasive Urothelial Carcinoma of the Bladder: An Observational Cohort Study of 97 Patients
- 2016
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Ingår i: Urologia internationalis. - : S. Karger AG. - 1423-0399 .- 0042-1138. ; 96:1, s. 83-90
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Tidskriftsartikel (refereegranskat)abstract
- <b><i>Introduction:</i></b> Hyperthermic mitomycin (HM) is a novel treatment modality for selected patients with high-risk non-muscle invasive bladder cancer (NMIBC). We sought to determine predictors of response to this therapy. <b><i>Patients and Methods:</i></b> A longitudinal, cohort study of 97 patients with high-risk NMIBC treated with ≥4 HM instillations on a prophylactic schedule was conducted. The primary outcome was time-to-progression survival; secondary outcomes were overall survival, cancer-specific survival, and adverse events. Descriptive statistics, Kaplan-Meier survival analyses, Cox proportional hazards modelling, and univariate and multivariable regression were performed. <b><i>Results:</i></b> The presence of initial complete response (CR; no evidence of disease at first check video-cystoscopy and urine cytology) post-HM treatment was an independent predictor of good response to HM. Female patients and those without carcinoma in situ (CIS) also appeared to respond better to the intervention. The overall bladder preservation rate at a median of 27 months was 81.4%; 17/97 (17.5%) patients died during the course of the study. <b><i>Conclusions:</i></b> High-risk NMIBC patients can be safely treated with HM and have good oncological outcome. However, those without an initial CR have a poor prognosis and should be counselled towards adopting other treatment methodologies such as cystectomy. Female gender and lack of CIS may be good prognostic indicators for response to HM.
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- Sooriakumaran, P, et al.
(författare)
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Reply to Gianluca Giannarini, Nazareno Suardi and Alberto Briganti's letter to the editor re: Prasanna Sooriakumaran, Abhishek Srivastava, Shahrokh F. Shariat, et al. A multinational, multi-institutional study comparing positive surgical margin rates among 22 393 open, laparoscopic, and robot-assisted radical prostatectomy patients. Eur Urol. In press. http://dx.doi.org/10.1016/j.eururo.2013.11.018
- 2014
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Ingår i: European urology. - : Elsevier BV. - 1873-7560 .- 0302-2838. ; 65:6, s. E91-E92
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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