Simultaneous nephrectomy and coronary artery bypass grafting through extended sternotomy

BACKGROUND: The advances in surgical techniques, resuscitation and anesthesiology support over the last years have allowed simultaneous thoracic and abdominal operations to be made for cancer and concomitant severe heart vessel disease relieving the patient from several diseases simultaneously and achieving long lasting remission or cure. CLINICAL CASE: A simultaneous nephrectomy and coronary artery bypass grafting procedure through extended sternotomy is reported. A 63-year-old man with severe coronary artery disease was found to have renal carcinoma. DIAGNOSIS: Postoperative pathological investigation of the tumor revealed the presence of renal cell carcinoma pT3a N0 M0, G2. Coronarography revealed advanced three-vessel coronary artery disease. TREATMENT: We successfully performed a simultaneous curative surgery for renal carcinoma and coronary artery bypass graft surgery under cardiopulmonary bypass using a novel technique of extended sternotomy. Simultaneous surgery thus appears to be a beneficial and safe approach for the treatment of coronary artery disease and resectable renal cancer in carefully selected patients

Ar galima remiantis objektyviais ikioperaciniais veiksniais prognozuoti ankstyvą biocheminį atkrytį po radikalios prostatektomijos?

Daimantas Milonas, Dainius Burinskas, Stasys Auškalnis, Mindaugas JievaltasKauno medicinos universiteto Urologijos klinika,Eivenių g. 2, LT-50009 KaunasEl paštas: [email protected] Tikslas Nustatyti objektyvius veiksnius, kurie leistų prognozuoti ankstyvą biocheminį atkrytį po radikalios prostatektomijos. Ligoniai ir metodai Į tyrimą įtraukti 142 prostatos vėžiu sergantys ligoniai, kuriems buvo atliktos radikalios prostatektomijos. Ankstyvas biocheminis atkrytis konstatuotas, kai prostatos specifinio antigeno koncentracija, praėjus 3 mėn. po operacijos, buvo >0,2 ng/ml. Neoadjuvantinė terapija (hormonų ar spindulių) buvo pagrindinis atmetimo kriterijus. Vertinta prostatos specifinio antigeno koncentracija, vėžio diferenciacijos laipsnis iki ir po operacijos, vėžio stadija, prostatos chirurginio šalinimo išlaidos. Rezultatai Galutinei analizei panaudoti 94 ligonų duomenys. Vidutinis jų amžius buvo 66,6 metų, prostatos specifinis antigenas iki operacijos – 9,87 ng/ml, Gleason diferenciacijos laipsnis iki operacijos – 5,87, diferenciacijos laipsnis po operacijos – 6,38, teigiami rezekciniai kraštai rasti 36 (38%), ankstyvas biocheminis atkrytis – 13 (14%) pacientų. Atlikus logistinę regresijos analizę nustatyta, jog ankstyvą biocheminį atkrytį galima patikimai prognozuoti, kai Gleason pooperacinis vėžio diferenciacijos laipsnis didesnis nei 7 (p = 0,02, tikimybių santykis – 7,8) ir vėžio stadija T3b (p = 0,012, tikimybių santykis – 6,76). Išvados Remiantis ikioperaciniais objektyviais veiksniais negalima patikimai prognozuoti ankstyvo biocheminio atkryčio. Prostatos vėžio išplitimas į sėklines pūsleles (T3b stadija) ir Gleasono pooperacinis vėžio diferenciacijos laipsnis > 7 leidžia reikšmingai prognozuoti ankstyvą biocheminį atkryti, po radikalios prostatektomijos, tokiems ligoniams indikuojamas ankstyvas adjuvantinis gydymas, nelaukiant biocheminio atkryčio požymių. Reikšminiai žodžiai: prostatos vėžys, radikali prostatektomija, ankstyvas biocheminis atkrytis Can objective preoperative parameters predict early biochemical recurrence after radical prostatectomy? Daimantas Milonas, Dainius Burinskas, Stasys Auškalnis, Mindaugas JievaltasClinic of Urology, Kaunas University of Medicine,Eivenių str. 2, LT-50009 Kaunas, LithuaniaE-mail: [email protected] Objective To estimate objective parameters which can be useful for predicting early biochemical recurrence after radical prostatectomy due to prostate cancer. Patients and methods The study embraced 142 patients that underwent radical retropubic prostatectomy. Early biochemical failure was defined as a prostate-specific antigen level 3 months after radical prostatectomy > 0.2 ng/ml. Neoadjuvant treatment (hormonal therapy or radiation) was the mane exclusion criteria. Preoperative antigen concentration, Gleason score at the biopsy, patients’ age, postoperative Gleason score, stage and surgical margins were investigated as possible predictors of early biochemical recurrence. Results Final analysis was done using data on 94 patients. The mean patients’ age was 66.6 years and mean preoperative prostate specific antigen concentration 9.87 (range 0.44–98.4) ng/ml. The mean Gleason score preoperatively was 5.87 (range 2–8) and postoperatively 6.38 (range 4–9). Positive surgical margins were in 36 (38%) and early biochemical failure was detected in 13 (14%) cases. Logistic regression analysis shows that postoperative Gleason score >7 (p = 0.02, OR-7.8) and stage pT3b (p = 0.012, OR-6.76) are powerful parameters for predicting early biochemical recurrence. Conclusions Preoperative parameters cannot predict early biochemical recurrence. Postoperative parameters such as Gleason score >7 and stage pT3b are useful in the prediction of early biochemical recurrence. In such patients early adjuvant treatment is advisable. Keywords: prostate cancer, radical prostatectomy, early biochemical recurrenc

Darolutamide and health-related quality of life in patients with non-metastatic castration-resistant prostate cancer : An analysis of the phase III ARAMIS trial

Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.BACKGROUND: In the ARAMIS trial, darolutamide plus androgen deprivation therapy (ADT) versus placebo plus ADT significantly improved metastasis-free survival (MFS), overall survival (OS) and time to pain progression in patients with non-metastatic castration-resistant prostate cancer (nmCRPC). Herein, we present analyses of patient-reported health-related quality of life (HRQoL) outcomes. PATIENTS AND METHODS: This double-blind, placebo-controlled, phase III trial randomised patients with nmCRPC and prostate-specific antigen doubling time ≤10 months to darolutamide 600 mg (n = 955) twice daily or matched placebo (n = 554) while continuing ADT. The primary end-point was MFS; the secondary end-points included OS and time to pain progression. In this analysis, HRQoL was assessed by the time to deterioration using the Functional Assessment of Cancer Therapy-Prostate (FACT-P) prostate cancer subscale (PCS) and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Prostate Cancer Module (EORTC QLQ-PR25) subscales. RESULTS: Darolutamide significantly prolonged time to deterioration of FACT-P PCS versus placebo (hazard ratio [HR] 0.80, 95% confidence interval [CI] 0.70-0.91; P = 0.0005) at the primary analysis (cut-off date: 3rd September 2018). Time to deterioration of EORTC QLQ-PR25 outcomes showed statistically significant delays with darolutamide versus placebo for urinary (HR 0.64, 95% CI 0.54-0.76; P < 0.0001) and bowel (HR 0.78, 95% CI 0.66-0.92; P = 0.0027) symptoms. Time to worsening of hormonal treatment-related symptoms was similar between the two groups. CONCLUSION: In patients with nmCRPC who are generally asymptomatic, darolutamide maintained HRQoL by significantly delaying time to deterioration of prostate cancer-specific quality of life and disease-related symptoms versus placebo.publishersversionPeer reviewe

Efficacy and Safety of Darolutamide in Patients with Nonmetastatic Castration-resistant Prostate Cancer Stratified by Prostate-specific Antigen Doubling Time : Planned Subgroup Analysis of the Phase 3 ARAMIS Trial

Background: Patients with nonmetastatic castration-resistant prostate cancer (nmCRPC) have a high risk of progression to metastatic disease, particularly if their prostate-specific antigen doubling time (PSADT) is ≤6 mo. However, patients remain at a high risk with a PSADT of >6 mo. Objective: To evaluate the efficacy and safety of darolutamide versus placebo in patients stratified by PSADT >6 or ≤6 mo. Design, setting, and participants: A planned subgroup analysis of a global multicenter, double-blind, randomized, phase 3 trial in men with nmCRPC and PSADT ≤10 mo was conducted. Intervention: Patients were randomized 2:1 to oral darolutamide 600 mg twice daily or placebo, while continuing androgen-deprivation therapy. Outcome measurements and statistical analysis: The primary endpoint was metastasis-free survival (MFS). Secondary endpoints were overall survival (OS) and times to pain progression, first cytotoxic chemotherapy, and symptomatic skeletal events. Quality of life (QoL) was measured using validated prostate-relevant tools. Safety was recorded throughout the study. Results and limitations: Of 1509 patients enrolled, 469 had PSADT >6 mo (darolutamide n = 286; placebo n = 183) and 1040 had PSADT ≤6 mo (darolutamide n = 669; placebo n = 371). Baseline characteristics were balanced between subgroups. Darolutamide significantly prolonged MFS versus placebo in both subgroups (unstratified hazard ratio [95% confidence interval]: PSADT >6 mo, 0.38 [0.26–0.55]; PSADT ≤6 mo, 0.41 [0.33–0.52]). OS and other efficacy and QoL endpoints favored darolutamide with significant improvement over placebo in both subgroups. The incidence of adverse events, including events commonly associated with androgen receptor inhibitors (fractures, falls, hypertension, and mental impairment), and discontinuations due to adverse events were low and similar to placebo. Limitations include small subgroup populations. Conclusions: In patients with nmCRPC and PSADT >6 mo (maximum 10 mo), darolutamide provided a favorable benefit/risk ratio, characterized by significant improvements in MFS, OS, and other clinically relevant endpoints; maintenance of QoL; and favorable tolerability. Patient summary: In patients with prostate cancer that has stopped responding to standard hormonal therapy (indicated by an increase in prostate-specific antigen [PSA] levels), there is a risk that the cancer will spread to other parts of the body. This risk is highest when the time it takes for the PSA level to double (ie, “PSA doubling time” [PSADT]) is less than 6 mo. However, there is still a risk that the cancer will spread even if the PSADT is longer than 6 mo. In a group of patients whose PSADT was more than 6 mo but no more than 10 mo, treatment with darolutamide slowed the cancer spread and allowed them to live longer than patients who received placebo (inactive drug). Darolutamide treatment did not cause many side effects and helped maintain patients’ quality of life without disruptions.publishedVersionPeer reviewe

Transition zone volume measurement – is it useful before surgery for benign prostatic hyperplasia?

Objective. The aim of this study was to estimate the equivalence and correlation between transition zone volume, measured by transrectal ultrasound, and removed prostate tissue weight in surgically treated patients due to benign prostatic hyperplasia. Material and methods. This study involved 168 patients with histologically confirmed benign prostatic hyperplasia. Of these patients, 120 underwent transurethral resection of the prostate and 48 – open prostatectomy. The weights of the specimens were compared with the corresponding volumes of the transition zone. Equivalence and correlation between transition zone volume and removed tissue weight were analyzed. Results. The mean (standard deviation, range) transition zone volume was 25.43 mL (±13.19, 5–61.6) in the transurethral resection group and 76.1 mL (±42.97, 13–275.8) in the open operation group. The mean removed tissue weight was 22.9 g (±13.41, 5–66) and 73.96 g (±44.96, 18– 280), respectively, in the transurethral resection and open operation groups. The correlation between removed tissue weight and transition zone volume was stronger in the open operation group than it was in the resection group (r=0.957, P&lt;0.001 vs. r=0.878, P&lt;0.001). There was a significant difference between transition zone volume and resected tissue weight (P=0.001). However, in the open operation group, there was an agreement between transition zone volume and enucleated tissue weight (P=0.263). Conclusions. A significant correlation was detected between removed tissue weight and transition zone volume. There is a significant difference between volume measurement and resected tissue weight while enucleated tissue weight was in agreement with transition zone volume when an open prostatectomy was performed

Significance of time until psa recurrence after radical prostatectomy without neo- or adjuvant treatment to clinical progression and cancer-related death in high-risk prostate cancer patients

Objective: The aim of our study was to evaluate the impact of time until biochemical recurrence (BCR) after radical prostatectomy (RP) without neo- or adjuvant treatment on clinical progression (CP) and cancer-related death (CRD) in high-risk prostate cancer (HRPCa) patients. Materials and methods: A total of 433 men with clinically HRPCa treated between 2001 and 2017 were identified. HRPCa was defined as clinical stage T2c and/or biopsy Gleason score (GS) 8 and/or preoperative prostate specific antigen (PSA) value 20 ng/ml. Exclusion criteria were neo- or adjuvant treatment and incomplete pathological or follow-up data. BCR was defined as two consecutive PSA values 0.2 ng/ml after RP. CP was identified as skeletal lesions, local or loco-regional recurrence. CRD was defined as death from PCa. All men were divided into two groups according to BCR. The chi-square and t-tests were used to compare baseline characteristics between groups. Biochemical progression free survival (BPFS), clinical progression free survival (CPFS), and cancer-specific survival (CSS) rates were estimated using Kaplan–Meier analysis. Patients with detected BCR were analyzed for prediction of CP and CRD with respect to time until BCR. The impact of baseline parameters on BCR, CP, and CRD was assessed by Cox regression analysis. Results: BCR, CP, and CRD rates were 47.8% (207/433), 11.3% (49/433), and 5.5% (24/433), respectively. Median (quartiles) time of follow-up after RP was 64 (40–110) months. Ten-year BPFS rate was 34.2%; CPFS, 81%; and CSS, 90.1%. Men with detected BCR were analyzed for prediction of CP and CRD with respect to time until BCR. The most informative cutoff for time from RP until CP and CRD was 1 year (p < 0.008). According to this cutoff, men were divided into two groups: BCR detected within 1 year and after a 1-year period. Ten-year CPFS was 49.8% in men with early BCR vs. 81.1% in men with late BCR; CSS was 70.9 vs. 92.8% (p = 0.001). Multivariable analysis[...]

Successful treatment of upper ureteral injury using renal autotransplantation

Introduction. Ureteral injuries are uncommon. Upper ureteral defect more than 7–8 cm in length is a challenge for urologists, requiring experience and several steps in its management. We report a case of iatrogenic upper urinary tract injury and successful treatment of 8-cm ureteral defect using autotransplantation of the kidney. Case report. A male patient underwent surgery due to retroperitoneal tumor. Iatrogenic ureteral injury was recognized 18 days after operation. Three-step management of urinary tract injury was performed. The first step included minimally invasive recovery of the urine flow and treatment of infection. The second step was unsuccessful renal descensus and new formation ureteropyeloanastomosis because of difficulties of kidney mobilization caused by previous surgery. The third step included a successful autotransplantation of the kidney and complete reconstruction of the urinary tract. Conclusions. Autotransplantation can be successfully used for the management of long upper ureteral injury in referral urological centers

Does Illness Perception Explain Quality of Life of Patients With Prostate Cancer?

Background. It is licely that illness perceptions can explain variations in quality of life of patients with prostate cancer across different treatment methods and stages. Therefore, the aim of this study was to determine if illness perception can explain variations in quality of life of patients with prostate cancer. Material and Methods. The cross-sectional national-level study was carried out. Quality of life was evaluated with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and the Visual Analogue Scale. Illness perceptions were measured by the revised Illness Perception Questionnaire. Results. The response rate was 77.1% (N=501). The variation in global quality of life was explained (32.0%) by levels of emotional representation (β=–0.126; P=0.023) and consequences (β=–0.209; P&lt;0.01); physical functioning (27.0%), by consequences (β=–0.203; P&lt;0.01) and chemotherapy (β=–2.911; P=0.007); role functioning (37.0%), by emotional representations (β=–0.198; P&lt;0.01), timeline cyclical (β=–0.209; P=0.014), and stage of the disease (β=–0.779; P=0.007); emotional functioning (43.0%), by emotional representations (β=–0.361; P&lt;0.01) and education level (β=–0.566; P=0.025); cognitive functioning (34.0%), by educational level (β=0.714; P=0.005), emotional representations (β=–0.118; P=0.019), illness coherence (β=–0.167; P=0.030), consequences (β=–0.187; P=0.001), and hormonal therapy (β=–0.778; P=0.049); and social functioning (39.0%), by consequences (β=–0.320; P&lt;0.01) and combined treatment (β=–1.492; P=0.016). Conclusions. Illness perceptions may be important while investigating quality of life in patients with prostate cancer. It may underlie quality-of-life differences in this group of patients and could inform decision makers about the importance of the provision of psychosocial services to patients with prostate cancer

Simultaneous nephrectomy and coronary artery bypass grafting through extended sternotomy

Abstract Background The advances in surgical techniques, resuscitation and anesthesiology support over the last years have allowed simultaneous thoracic and abdominal operations to be made for cancer and concomitant severe heart vessel disease relieving the patient from several diseases simultaneously and achieving long lasting remission or cure. Clinical case A simultaneous nephrectomy and coronary artery bypass grafting procedure through extended sternotomy is reported. A 63-year-old man with severe coronary artery disease was found to have renal carcinoma. Diagnosis Postoperative pathological investigation of the tumor revealed the presence of renal cell carcinoma pT3a N0 M0, G2. Coronarography revealed advanced three-vessel coronary artery disease. Treatment We successfully performed a simultaneous curative surgery for renal carcinoma and coronary artery bypass graft surgery under cardiopulmonary bypass using a novel technique of extended sternotomy. Simultaneous surgery thus appears to be a beneficial and safe approach for the treatment of coronary artery disease and resectable renal cancer in carefully selected patients.</p