Clinical and Pathologic Factors In Breast Cancer Patients with Bone Metastases Undergoing Surgery for Pathologic and Impending Fractures

Introduction: Metastatic lesions to bone carry a poor prognosis. Bone lesions can be responsible for significant morbidity in patients, including pathologic or impending fractures that may require emergent surgical evaluation. Objective: We evaluated the clinical and pathologic features associated with breast cancer patients with bone metastases who underwent surgery for pathologic or impending fractures. Methods: A retrospective chart review of 20 breast cancer patients with bone metastases who underwent surgery from the Bone Biorepository Bank at Sidney Kimmel Cancer Center was performed. We evaluated their clinical and pathologic characteristics and performed Fisher’s Exact Testing to explore potential associations. Results: 90% and 15% of patients received systemic chemotherapy and bone directed radiation prior to surgery, respectively. The average time between diagnosis to surgery was 6.21 years and the average patient age was 63 years. 60% of the tumor specimens demonstrated medium or high tumor burden. Similarly, 70% of the tumor specimens demonstrated a medium or high stromal proliferative response. On Fisher’s Exact Test, while both stromal proliferative response and tumor burden trended towards an association, this was not found to be statistically significant. Discussion: Breast cancer patients undergoing surgery for boney metastasis were noted to have a wide range of ages and time from diagnosis to surgery. While there was a higher percentage of patients with tumors of high and medium tumor burden and stromal proliferative response, this trend was not found to be statistically significant. Future studies with larger sample sizes are required to determine the relationship between these features

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Patient Factors Impacting Perioperative Outcomes for T1b-T2 Localized Renal Cell Carcinoma May Guide Decision for Partial versus Radical Nephrectomy

There remains debate surrounding partial (PN) versus radical nephrectomy (RN) for T1b-T2 renal cell carcinoma (RCC). PN offers nephron-sparing benefits but involves increased perioperative complications. RN putatively maximizes oncologic benefit with complex tumors. We analyzed newly available nephrectomy-specific NSQIP data to elucidate predictors of perioperative outcomes in localized T1b-T2 RCC. We identified 2094 patients undergoing nephrectomy between 2019-2020. Captured variables include surgical procedure and approach, staging, comorbidities, prophylaxis, peri-operative complications, reoperations, and readmissions. 816 patients received PN while 1278 received RN. Reoperation rates were comparable; however, PN patients more commonly experienced 30-day readmissions (7.0% vs. 4.7%, p = 0.026), bleeds (9.19% vs. 5.56%, p = 0.001), renal failure requiring dialysis (1.23% vs. 0.31%, p = 0.013) and urine leak or fistulae (1.10% vs. 0.31%, p = 0.025). Infectious, pulmonary, cardiac, and venothromboembolic event rates were comparable. Robotic surgery reduced occurrence of various complications, readmissions, and reoperations. PN remained predictive of all four complications upon multivariable adjustment. Several comorbidities were predictive of complications including bleeds and readmissions. This population-based cohort explicates perioperative outcomes following nephrectomy for pT1b-T2 RCC. Significant associations between PN, patient-specific factors, and complications were identified. Risk stratification may inform management to improve post-operative quality of life (QOL) and RCC outcomes

Stent vs. Stent-less Ileal Conduits After Radical Cystectomies: Is There Difference In Early Postoperative Outcomes?

Placing ureteral stents at the ureteroileal anastomosis for radical cystectomy with ileal conduit (RCIC) diversion has long been common practice, which has recently been called into question. In this study, we aim to investigate the difference in 30-day outcomes between patients who did and did not receive ureteral stents after RCIC.https://jdc.jefferson.edu/urologyfposters/1003/thumbnail.jp

You Are What You Eat: Effects of Selenium and Environmental Toxins on Child Developmental Delays: A Case-Control Study in Taiwan

This epidemiological study looked at the interactions between selenium, mercury, lead, and arsenic and their associations with developmental delays. This study was designed as an observational case-control study in which subjects were recruited based on their outcome, or disease, status, which in this case meant cases were children developmental delays and controls were children with normal neurodevelopment. Mercury, lead, and arsenic ingestion of varying degrees have been linked to neurodevelopmental problems, and selenium has been suggested as a potential buffer against mercury toxicity. Blood and urine samples were collected from cases (N=85) and controls (N=85) recruited at Shin Kong Wu Ho-Su Memorial Teaching Hospital between August 2010 and December 2014. All subject mothers were given a questionnaire about sociodemographic and health status for herself and her child. Blood selenium, mercury, and lead concentrations were measured using Inductively coupled plasma mass spectrometry (ICP-MS), and urinary arsenic species concentrations were measured using high-performance liquid chromatography with hydride generation atomic absorption spectrometry (HPLC/HG-AAS). The children’s and mother’s sociodemographic, health, and heavy metal concentrations were compared between cases and controls. Selenium, mercury, lead, and total arsenic all showed significant difference between cases and controls. All significant factors from were added into multivariate analysis to find direct association between the heavy metals and developmental delays. The models that included the most sociodemographic and health variables showed that selenium (Odds Ratio 1.01, 95% Confidence Interval 0.98-1.02) and corrected total arsenic (OR 1.01, 95% CI 0.98-1.03) were not significantly associated with developmental delays. Mercury (OR 1.30, 95% CI 1.05-1.84), Lead (OR 1.33, 95% CI 1.05-1.64), and total arsenic (OR 1.04, 95% CI 1.01-1.07) were directly associated with developmental delays. In logistic models, selenium and mercury were the only elements to shown an interaction. Selenium was significantly different between cases and controls but not significantly associated with decreasing developmental delays on its own. Mercury is significantly associated with increasing developmental delays on its own, but when selenium is present, the association disappears. This study is the first to look at these four metals in a human population, their correlations, and interactions in the context of developmental delays. We conclude: 1) selenium intake is important for normal brain activity and also for buffering the toxicity of mercury; 2) mercury has detrimental effects on neurodevelopment its own but can be prevented by the presence of selenium; 3) lead is associated with developmental delays at all levels of exposure; and 4) arsenic is potentially associated with developmental delays, but further research on the most accurate measure of arsenic concentration in human bodies is needed. Because this study was done on a human population and not in a lab or on animals, the findings can be used to develop policies to regulate environmental toxins, to determine levels of concerns, and to monitor of selenium intake

Patient Factors Impacting Perioperative Outcomes for T1b-T2 Localized Renal Cell Carcinoma May Guide Decision for Partial versus Radical Nephrectomy

There remains debate surrounding partial (PN) versus radical nephrectomy (RN) for T1b-T2 renal cell carcinoma (RCC). PN offers nephron-sparing benefits but involves increased perioperative complications. RN putatively maximizes oncologic benefit with complex tumors. We analyzed newly available nephrectomy-specific NSQIP data to elucidate predictors of perioperative outcomes in localized T1b-T2 RCC. We identified 2094 patients undergoing nephrectomy between 2019–2020. Captured variables include surgical procedure and approach, staging, comorbidities, prophylaxis, peri-operative complications, reoperations, and readmissions. 816 patients received PN while 1278 received RN. Reoperation rates were comparable; however, PN patients more commonly experienced 30-day readmissions (7.0% vs. 4.7%, p = 0.026), bleeds (9.19% vs. 5.56%, p = 0.001), renal failure requiring dialysis (1.23% vs. 0.31%, p = 0.013) and urine leak or fistulae (1.10% vs. 0.31%, p = 0.025). Infectious, pulmonary, cardiac, and venothromboembolic event rates were comparable. Robotic surgery reduced occurrence of various complications, readmissions, and reoperations. PN remained predictive of all four complications upon multivariable adjustment. Several comorbidities were predictive of complications including bleeds and readmissions. This population-based cohort explicates perioperative outcomes following nephrectomy for pT1b-T2 RCC. Significant associations between PN, patient-specific factors, and complications were identified. Risk stratification may inform management to improve post-operative quality of life (QOL) and RCC outcomes

A Narrative Review on Robotic Surgery as Treatment for Renal Cell Carcinoma with Inferior Vena Cava Thrombus.

Renal cell carcinoma (RCC) is a common diagnosis, of which a notable portion of patients present with an extension into the venous circulation causing an inferior vena cava (IVC) tumor thrombus. Venous extension has significant implications for staging and subsequent treatment planning, with recommendations for more aggressive surgical removal, although associated surgical morbidity and mortality is relatively increased. The methods for surgical removal of RCC with IVC thrombus remain complex, particularly surrounding the use of robot-assisted surgery. Robot assistance for radical nephrectomy in this context is recently emerging. Thrombus level has important implications for surgical technique and prognosis. Other preoperative considerations may include location, laterality, size, and wall invasion. The urology literature on treatment of such tumors is largely limited to case series and institutional studies that describe the feasibility of various surgical options for these complex tumors. Further understanding of the outcomes and patient-specific risk factors would shed increased light on the optimal treatment for such cases. This narrative review provides a thorough overview on the previously reported use of robot-assisted nephrectomy in RCC with IVC thrombus to inform further studies which may optimize outcomes and guide shared decision-making

A Narrative Review on Robotic Surgery as Treatment for Renal Cell Carcinoma with Inferior Vena Cava Thrombus

Renal cell carcinoma (RCC) is a common diagnosis, of which a notable portion of patients present with an extension into the venous circulation causing an inferior vena cava (IVC) tumor thrombus. Venous extension has significant implications for staging and subsequent treatment planning, with recommendations for more aggressive surgical removal, although associated surgical morbidity and mortality is relatively increased. The methods for surgical removal of RCC with IVC thrombus remain complex, particularly surrounding the use of robot-assisted surgery. Robot assistance for radical nephrectomy in this context is recently emerging. Thrombus level has important implications for surgical technique and prognosis. Other preoperative considerations may include location, laterality, size, and wall invasion. The urology literature on treatment of such tumors is largely limited to case series and institutional studies that describe the feasibility of various surgical options for these complex tumors. Further understanding of the outcomes and patient-specific risk factors would shed increased light on the optimal treatment for such cases. This narrative review provides a thorough overview on the previously reported use of robot-assisted nephrectomy in RCC with IVC thrombus to inform further studies which may optimize outcomes and guide shared decision-making